Sustainable Medical and Wellness Destinations: Client-, Result- and Innovation-Focussed Case Studies by UTAD

Sustainable Medical and Wellness Destinations Client- , Result- and Innovation-Focussed Case Studies

Organization

Veronika Joukes Funding

Lina Lourenรงo-Gomes Alexandra Marta-Costa

Publishing Details

Title Sustainable Medical and Wellness Destinations. Client-Result- and Innovation-Focussed Case Studies

Editors Veronika Joukes Lina Lourenรงo-Gomes Alexandra Marta-Costa

Publisher Universidade de Trรกs-os-Montes e Alto Douro

ISBN 978-989-704-162-4

Publishing date December 2013

Design & page layout www.hldesign.pt

This book is distributed free of charge and is not intended for sale, thanks to the funding of

Index Introduction ......................................................................................................................4 Veronika Joukes, Alexandra Marta-Costa, Lina Lourenço-Gomes

Part 1

CLIENT Focussed Case Studies ........................................................8

1.1.. Service Quality Measurement in North Portuguese Thermal Tourism ...............................................................................9

Rosa Maria Riveiro Conde, Andrés Mazaira and Patrício Ricardo Soares Costa 1.2. The Importance of Relationship Marketing for Thermal Spas: A Case Study of the Dão-Lafões Region.................22

Joaquim Antunes 1.3. Mature Spa Travellers in Taiwan .....................................................................................................................................................................37

Mei-Ting Hsieh and Timothy J. Lee

Part 2

RESULT Focussed Case Studies ......................................................45

2.1. Socioeconomic Impacts of Health Tourism: An Analisys of a Portuguese Programme .......................................46

Maria João Carneiro, Celeste Eusébio, Elisabeth Kastenholz and Helena Alvelos 2.2. Critical Analysis of the Australian Spa Hotel Industry ..................................................................................................................60

Timothy J. Lee 2.3. Ryokan Facilities in Japan Compared With Spa Hotels in Australia ......................................................................................71

Timothy J. Lee and Boram Lim

Part 3

INNOVATION Focussed Case Studies ........................................80

3.1. Well-being in Spas: Residents’ and Tourists’ Perspectives ..........................................................................................................81

Ana Isabel Renda, J. da Costa Mendes and P. Oom do Valle 3.2. Thermal Tourism Through the Audiovisual Sector – A New Tool for Promotion: The Case of Ourense, Thermal Capital ............................................................................................................................................................................................................93

Noelia Araújo Vila e José Antonio Fraiz Brea 3.3. Health and Wellness in the Guadaíra Basin, Spain ........................................................................................................................109

J. Raúl Navarro García e Frederico Alvim 3.4. Rural Well-Being Tourists: Online Information Search Behaviour ......................................................................................124

Anja Tuohino and Juho Pesonen

Conclusions .................................................................................................................136 Veronika Joukes

Introduction

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Introduction Veronika Joukes Alexandra Marta-Costa Lina Lourenço-Gomes

From 13 to 15 October 2011, two research centres of the University of Trás-os-Montes and Alto Douro – the Centre for Transdisciplinary Development Studies (CETRAD) and the Centre for Research in Sports Sciences, Health and Human Development (CIDESD) – joined forces to celebrate the centenary of the beginning of tourism in Portugal by organising the international conference ‘Sustainable Health and Wellness Destinations’ about the interconnections between tourism, history and health and wellness.

Sponsors and Partners From the beginning, the organising committee invested a lot of energy in networking, as it was its intention to strengthen relationships between the most diverse stakeholders of the medical and wellness tourism sector in the euroregion Galicia-North of Portugal. Therefore, the list of partners and sponsors is very extensive.1 On the Portuguese side, we would like to mention the municipality of Chaves, AETUR, ADIRBA, CETIES, ADITEC, ULP, ADRAT, AMAT, Turismo de Portugal, Porto e Norte de Portugal, ATP, Centenário do Turismo, FCT, Hotel Casino of Chaves (Solverde), Vidago Palace Hotel (Unicer), Termas de Chaves, Termas de Pedras Salgadas, Termas do Norte de Portugal, AQUATOUR, and the journal Turismo & Desenvolvimento. On the Galician side, we give special thanks to Xunta da Galicia – Secretaria Geral para o Turismo, TurGalicia, University of Vigo (Master of Tourism in Ourense), AEITE, GAL, TermaRed, Termatalia, and Observatorio do Termalismo. At the international level, we could count on the full support of the special interest group ‘Health and Wellness Tourism’ of the Association for Tourism and Leisure Education (ATLAS). Most of the credit, however, must be given to CCDR - Norte, ON2, and EU – FEDER2 who funded the whole event (inclusive of the edition of the book of abstracts, the proceedings and the present book) coded as NORTE-070927-FEDER-000197 – CHAVES 2011 – (From Villes Thermales to) Sustainable Health and Wellness Destinations.3

For more details, please see http://chaves2011.wikispaces.com/Organizing+Institutions+%2A+Partners%2A+Sponsors.

The North Regional Coordination and Development Commission (CCDR-N) is a decentralized body of central government. Its mission is to promote the conditions permitting the integrated and sustainable development of Portugal North Region (NUTS II), thereby contributing to the national cohesion and competitiveness (http://www.ccdr-n.pt/pt/portugal-north-region/ccdr-n/, accessed 20 November 2013). ON.2 - O Novo Norte - North Portugal Regional Operational Program 2007/2013 - is a financial instrument which supports regional development in the north of Portugal. Financed entirely by the European Regional Development Fund (ERDF/FEDER), ON.2 constitutes the most significant general financial allocation for regional operating programs (http://www.novonorte.qren.pt/pt/menu-topo/english-version/, accessed 20 November 2013). 2

A proposal was submitted in the field of “Promoting and Enabling Institutions – Internationalization” - PCI-I/2/2010 in December 2010 and a financial contract was concluded in October 2011. 3

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

The City of Chaves: A Source of Inspiration

The conference was held in Chaves, a traditional hot spring town near the Galician border. Along with the Spanish neighbouring Verín, it forms a eurocity. Together, they plan to take greater advantage of their thermal springs in the future by opening, for example, a specialised research and training centre. In 2004, while excavations were underway in front of the local court building to construct an underground parking lot, the original Roman thermae were discovered near the present historic centre of Chaves, with thermal water (around 71° C) still naturally boiling over in them. Everything is now being prepared to turn this artefact into a museum. These are some of the reasons why we chose this city to host the international conference ‘Sustainable Health and Wellness Destinations’ in October 2011. Another was the fact that the University of Trás-os-Montes and Alto Douro offers a Bachelor’s Degree in Tourism in Chaves, so we could count on the help of its teachers and students, as well as the Department of Economics, Sociology and Management (DESG) to which it belongs and the research centre (CETRAD) with which it is associated. Other factors were the fact that Chaves is a good practice example of and a stimulating power behind the programming and execution of the development plans for the health and wellness tourism segment, defined as a strategic tourism product for Portugal at both national and regional levels. The conference at Chaves turned out to be a meeting point for experts from different areas to gather and reflect on medical and wellness tourism in the broadest sense. With this book, we want to share worldwide some very interesting practice case studies presented by the conference participants.

Why This Book? Why This Title? According to the Research Report: Global Spa Summit 2011. Wellness Tourism and Medical Tourism: Where Do Spas Fit?, the terms medical, wellness and health tourism are being used worldwide in an erratic and confusing way. The report advises the establishment of clear and consistent definitions for medical tourism and wellness tourism based on the characteristics and motivations of travellers, not the characteristics of the destinations they are visiting, and an emphasis on the distinctions between the two. Moreover, we should minimise the use of the term health tourism. That is why we varied the original title of the conference, based on the official designation of the corresponding strategic tourism product in Portugal, turismo de saúde e bem-estar, while choosing the current book title: Sustainable Medical and Wellness Destinations: Client-, Result- and Innovation-Focussed Case Studies. We also would like to emphasise that one of the secondary aims of the Chaves 2011 conference was to draw attention to the fact that Portugal within the medical and wellness segment is doing much more than simply providing quality services in (mineral spring) spas. The conference was also a plea for all possible suppliers of this niche to work together and inspire each other. In this book, we gather some of the scientifically supported case studies presented at the conference. We offer these studies in English in order to share with the world what is actually being done in Portugal in the area of medical and wellness tourism, and also to show that the essence of what is currently happening in this country is very similar to or can be easily adapted to situations in completely different contexts all over the world. This being said, only one obligation remains: presenting and commenting on the structure of the book. We concentrate on three crucial themes – clients, results and innovation – for anyone working in the sector, all of them linked more or less directly with the principles of sustainability. Each theme corresponds to one of the book’s three parts and is explored in three or four chapters.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

The Scope of the Book In a first client-focussed section (Part 1), Rosa Maria Riveiro Conde, Andrés Mazaira and Patrício Ricardo Soares Costa surveyed customers of northern Portuguese thermal tourism units about their perceptions of the service quality (Chapter 1.1). Joaquim Antunes then relates the results of a questionnaire he distributed among clients at similar businesses in the centre of Portugal in order to highlight the importance of relationship marketing for the medical and wellness tourism branch (Chapter 1.2). Finally, Mei-Ting Hsieh and Timothy Lee present the outcome of their questionnaire survey, carried out at Taiwanese (thermal or mineral spring) spa destinations to determine the most important motivations of clients, and formulate some changes that should be made with regard to the elaboration of more efficient marketing strategies (Chapter 1.3). Maria João Carneiro, Celeste Eusébio, Elisabeth Kastenholz and Helena Alvelos open the second part that concentrates on result-focussed case studies (Part 2) with their analysis of the socioeconomic impacts of a Portuguese social health tourism program at micro and macro levels in Portugal (Chapter 2.1). Timothy Lee ends his critical analysis of the Australian spa hotel industry with a list of very concrete recommendations that can immediately be implemented by medical and wellness tourism business owners and authorities (Chapter 2.2). He and Boram Lim co-authored and obtained similarly concrete outcomes when comparing the same subsector, spa hotels in Australia, with ryokan facilities in Japan (Chapter 2.3). Also very practical are the results of the innovation-focussed case studies (Part 3). Ana Isabel Renda, Júlio da Costa Mendes and Patrícia Oom do Valle suggest that the wellness potential of the spas at hotels in Loulé (Algarve) should also be used by the residents in order to combat seasonality and increase profitability (Chapter 3.1). Using the example of Ourense, the Galician spa capital, Noelia Araújo Vila and José Antonio Fraiz Brea argue for marketing these kinds of destinations by using them as locations for the making of (parts of) soap opera series, films, and so forth (Chapter 3.2). Jesús Raúl Navarro García and Frederico Alvim stress the potential of the natural surroundings for marketing medical and wellness destinations (Chapter 3.3). Finally, analysing the online information search behaviour of Finnish rural well-being tourists, Anja Tuohino and Juho Pesonen come to very practical conclusions that, like all the case studies presented in this book, can inspire other players in the medical and wellness sector (Chapter 3.4). Please note that in the conclusion we were careful to group the main outcomes of the case studies in order to help those with little time access easily the core of what is dealt with in a very thorough way in the different chapters of this book. We hope you will enjoy reading through the case studies included here and that you can take advantage of the scientific outcomes of each and every case study we selected for you. All collaborating authors are fully responsible for the concepts, texts, graphs, figures, citations, references and so forth they present. Their views do not necessarily reflect the opinion of the editors.

PART 1

CLIENT Focussed CASE STUDIES

Go to Index

Service Quality Measurement in North Portuguese Thermal Tourism

1.1.

ROSA MARIA RIVEIRO CONDE * ANDRÉS MAZAIRA ** PATRÍCIO RICARDO SOARES COSTA ***

* PhD in Business Administration at the Universidad Rey Juan Carlos (Service Marketing and Tourism). ** PhD in Business Administration at the Universidad de Vigo. Assistant Professor of Marketing at the Universidad de Vigo. *** PhD in Contemporary Political Processes (Political Marketing and Voting Behaviour) at the Universidad de Santiago de Compostela. Assistant Professor of Statistics I and II applied to Psychology at the Faculty of Psychology and Education Sciences – Universidade do Porto and Biostatistics in Health Sciences at the School of Health Sciences – Universidade do Minho.

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.1.

Abstract 15 The aim of this study is to analyse the different dimensions of service quality applied to thermal spa tourism. Defining and measuring service quality is important to this sector because it contributes to its success and influences customer satisfaction. In 2009, the demand for wellness tourism experienced a significant increase of 13.5% compared with 2008. In the north of Portugal, the segments of classical spa tourism accounted for a share of 80%, and the wellness segment had almost 5,000 users (20% of the total). The research was developed with spa customers in the north of Portugal. An adaptation of the SERVPERF scale was used to measure the service quality. Although the original SERVPERF scale contained 22 items, after the analysis of the pre-test, one item (assurance) was eliminated, because it was irrelevant. Each of the 21 items of the scale was rated on a 7-point Likert scale. SERVPERF (the performance component of the Service Quality scale), has been shown to measure 5 underlying dimensions: tangibility, reliability, responsiveness, assurance and empathy. The data were collected using a self-administered questionnaire. The sample consisted of 832 respondents (46% male, 54% female, age average: 62.82). A descriptive statistical analysis was undertaken (average, standard deviation and frequencies). The dimensionality of the scale was explored and confirmed through a main components analysis with a Varimax rotation technique and a confirmatory factor analysis. The dimensions’ reliability was measured using the Cronbach’s alpha. The results indicate that the nature of perceived service quality measurement instruments in spa services has three dimensions: employees’ professionalism, tangibility and empathy. Employees’ professionalism explains 46.2% of the total variance. Nevertheless, the three dimensions found explain 60.9% of the total variance.

Keywords: perceived service quality, thermal Spa tourism, SERVPERF, SERVTHERM.

1.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1. Introduction Nowadays, the tourism sector is determinant in any country, not only due to the wealth and employment it creates, but also because it is a booster of development in the world’s economies.

Tourism arose as one of the most important economic and social phenomenon of the twentieth century. In fact, since the 1950s, tourism’s expansion worldwide has been exponential. The number of international tourist arrivals is anticipated to increase from 25 million in 1950 to 1.56 billion in 2020, according to data from the World Tourism Organization. Therefore, in the next few years, tourism will become the main economic activity in the world, surpassing, as far as exports are concerned, the sectors connected to the oil and car industries (UNWTO, S.d.). From a qualitative point of view, it will be necessary to develop the concepts of active holidays and of varied and complementary tourism products. There will be more competitiveness among the different destinations. New destinations will appear; others will undergo a decline. Today, tourism is greatly diversified. Travel tends to be spread throughout the year. Holidays’ typologies are themselves more varied, whether we are talking about the goal of the trip, its duration or even the lodging type. It is becoming much more usual to have shorter holidays in the summer and other holiday periods during the year. This change has generated an increment in the segments of cultural, sports, adventure and wellness tourism (Fazenda, 2008). Within these new tourism products is thermal spa tourism, which can be defined as a set of activities related to the therapeutic use of natural mineral water. In the last few years, thermal spa tourism has been associated not only with purely medical and healing components, but also with other elements, such as prevention, leisure and wellness, capable of attracting other types of clients. Accordingly, two different areas can be identified in thermal spa tourism: classical (therapy and rehabilitation) and wellness (prevention and promotion of physical and psychic health). These two possibilities are market niches with divergent characteristics and needs. In the first case, we are dealing with an emerging market that needs intervention regarding its consolidation. These two segments have been allowing the reduction of seasonality in spa resorts, considering that the wellness segment compensates for the summer period concentration provoked by the classical segment demands (Programa de Acção de Enfoque Temático, 2009: 28). Thermal spa tourism is a sub-sector with great potentiality and increasing importance. Remodelling of its universe is, therefore, necessary, with the modernization of the facilities and a varied offer of services, without a focus on the cure concept, but also covering leisure, prevention, beauty and wellness. Thus, the new image of spas, instead of emphasizing their traditional image as centres for illness treatments, will have to be oriented towards wellness, the search for body cult and leisure. The non-seasonal component of thermal spa tourism (classical) facilitates an elevated occupation index throughout the entire year, reaching total occupation for 10 months. The average permanence/stay at a spa resort is longer due to the duration of spa treatments (10 to 15 days), much longer than any other tourism type. Usually, spas are located in interior areas, thus being drivers of local development (Alén and Rodriguez, 2004: 3). The present work aims to elaborate a scale to measure quality perceived by spa clients. The measurement instrument was developed from the SERVPERF scale (Cronin and Taylor, 1992) and applied in the spas of Porto and the North of Portugal.1

This is Portugal’s most northern NUTS 2 region.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.1.

2. Perceived Quality Measurement in Thermal Spa Tourism The quality of products and services has become a main issue since the 1980s. Companies needed to differentiate themselves from their competitors due to the increasing competition and the fast deregulation of the sector (Parasuraman et al.., 1988: 12). Service quality is considered a determinant factor as far as competitiveness is concerned, thus becoming a differentiating element (Ghobadian et al.., 1994: 44). In spite of being a vastly debated concept, the definition of service quality is not consensual at all. One of the most-used definitions comes from Parasuraman et al. (1988). To these authors, perceived quality is the extent of the discrepancies or the existent differences between the clients’ expectations or wishes and their perceptions. The interest in the study of quality in the area of tourism is directly connected with its impact in terms of the competitiveness of the products and tourism destinations, within the context of a scenario characterized by the globalization of the offer and by a more exigent demand and a more profound knowledge of tourists regarding the options available to them (Silva et al., 2001). The delivery of a quality tourism service is an element of strategic differentiation. This fact is due to the evolution of consumption habits and the increasing growth of competitiveness among tourism companies (Grande et al., 2002: 81). According to Kandampully (2000), quality in tourism will be the main differentiation factor in the sector’s competitiveness. To provide the definition of a quality strategy in tourism, it will be necessary, among other aspects, to have competent and motivated human resources, to integrate sustainable environmental and tourism policies and to create a network of stakeholders as well as a set of personalized services (Eraqui, 2006: 475). In 2003, the World Tourism Organization defined six aspects to take into consideration when defining tourism products or services and marketing strategies. These criteria are: (1) safety: a tourism product or service cannot represent danger to life or health; (2) hygiene; (3) accessibility: tourism products and services must be accessible to all, even to people with some sort of incapacity; (4) transparency: effective communication of all the characteristics of the tourism product as well as its price, a key element in order to shape true expectations; (5) authenticity: one of the most subjective factors of quality measurement, which is a cultural dimension that allows a tourism product to be different from another one with identical characteristics and that has to meet consumers’ expectations; and (6) harmony: harmony with the personal and environmental surroundings, thus contributing to sustainable tourism. Unlike other activities, tourism consumers (tourists) typically buy and consume a varied set of services, also known as “the holiday experience” (Weiermair, 2000: 398). As such, it is difficult to define and create a quality service in tourism. However, it is agreed that quality in tourism can be measured through the satisfaction level of the tourists with the different services that are provided, with the possible consequence of their return and recommendations. In the last few decades, several models to measure service quality have been created and developed, defining the client as the central axis of these evaluations, such as the SERVQUAL model (Parasuraman et al., 1988) and SERVPERF (Cronin and Taylor, 1992). The first model is a multiple-item instrument that measures the five dimensions or determinants of service quality: reliability, tangibility, safety, responsibility and empathy. In the

1.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

original model, ninety-seven items were generated (approximately ten items for each dimension), which represented the different aspects of service quality identified by Parasuraman et al. (1985: 17). This model has been successively improved, originating a twenty-two-item scale with the five definitive dimensions of SERVQUAL (three original and two combinations): tangibility (a set of tangible elements), reliability (the ability to provide the service with accuracy and fulfil the promises), responsiveness (being available to help the clients quickly), safety (the ability to show confidence and knowhow) and empathy (accessibility and the capacity to personalize the service). The last two dimensions (safety and empathy) include items from the original seven dimensions – communication, credibility, safety, competence, courtesy, knowledge and access. Each item leads to two statements, one to measure the consumers’ expectations of a specific sector and the other to measure the perceptions regarding a company from that sector. The score of each item, which represents the service quality perceived by the consumer, is determined by the scoring difference between perceptions and expectations. On the other hand, the second model uses only the service performance perceptions, considering that the clients are not based on the existing differences between expectations and perceptions. Even though they do not agree with the theoretical assumptions that sustain the SERVQUAL model, the dimensions used in the scale are adequate to represent the service quality. To justify their model, Cronin and Taylor (1992) state that quality’s conceptualization is more than just a client’s attitude regarding the quality dimensions; therefore, it cannot be measured based on the satisfaction model by Oliver (1980), i.e., it must not be measured based on the differences between expectations and performance, but as a performance perception. Having taken into consideration the specificities of the tourism sector, some adaptations of these scales have appeared, such as LODGSERV (Knutson et al., 1990) to measure service quality in hotels, LOGQUAL by Getty and Thompson (1994) for the hotel industry, DINESERV for restaurants (Stevens et al., 1995), HOTELQUAL (Falces et al., 1999) for lodging facilities, HISTOCAL for historic houses (Frochot and Hughes, 2000) and ECOSERV for ecotourism (Kan, 2003). Concerning thermal spa tourism in Portugal, the work produced until now on service quality is practically non-existent. Thus, this article aims to contribute to the creation of an evaluation model of perceived service quality in thermal spas.

3. Methodology The purpose of this investigation is to validate an evaluation scale for the quality perceived by the clients of thermal spas in Porto and the North of Portugal. In accordance with this goal, a 22-item scale was initially defined. After the pre-test analysis, it was clear that 1 of the items in the safety dimension was not significant, which led to its elimination. The final 21-item scale, which we denominate SERVTHERM, is based on the SERVQUAL model of Parasuraman et al. (1985, 1988, 1991), on the SERVPERF scale (Cronin and Taylor, 1992, 1994), as well as on several other investigations in the area of tourism (Alén, 2003; Grande et al., 2002; Ramsaran-Fowdar, 2004; Snoj, 1995; Snoj and Mumel, 2002). During the elaboration of the SERVTHERM scale items, some items were eliminated, others were adapted and several items specifically relating to the spa context were included, namely the natural surroundings of spas, the existence of permanent medical assistance, the variety and quantity of treatments, the quality of medicinal waters and the adaptation of the schedules to the various clients. All the questions were written in a positive manner, as suggested by Carman (1990) and Parasuraman et al. (1994). The scale is presented in Figure 1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.1.

Figure 1 | SERVTHERM Scale 1. The equipment of the spa ***** is modern 2. The decoration of the spa ***** is simple and welcoming Tangibility

3. The collaborators of the spa ***** have a careful and professional look 4. The spa ***** has a very beautiful natural surrounding 5. The spa***** is well located 6. The employees of the spa ***** have a good knowledge when dealing with clients (they know the business)

Reliability

7. When the clients have a problem, the spa ***** solves it 8. The services provided by the spa ***** are trustworthy 9. The services of the spa ***** are provided on schedule 10. The clients of this spa ***** are accurately informed about the services’ schedules

Responsiveness

11. The employees of the spa are always willing to help the clients 12. In the spa ***** there is permanent medical assistance 13. The spa ***** has a great variety and quantity of treatments (medical and beauty) 14. The medicinal and mineral waters of this spa ***** have great quality and are in perfect conditions

Safety

15. The behaviour of the employees of this spa ***** conveys trust to their clients 16. 16. The employees of the spa ***** are prepared to answer to their clients 17. The behaviour of the employees in the spa ***** is friendly and familiar 18. The clients of this spa ***** always receive personal attention

Empathy

19. The schedules of this spa ***** are flexible and adapted to the various clients 20. The employees of this spa ***** have the capacity to recognize the clients’ needs 21. The problems of the clients in the spa ***** are always solved

The importance of each component was measured using a Likert scale of 7 points, ranging from “1 – I totally disagree” to “7 – I totally agree”. The fieldwork took place between 11 August and 22 October 2010. These dates were chosen because they included a regular holiday period as well as the time of year during which spas have more clients. The questionnaires were conducted in six spa facilities: Termas de Chaves (n=250; 30%), Termas das Taipas (n=69; 8.3%); Termas de Caldelas (n=148; 17.8%); Termas do Gerês (n=200; 24%); Termas de S. Jorge (n=149; 17.9%); and Caldas de Carlão (n=16; 1.9%). In the gathering of information during the fieldwork, the following points were applicable: a) the information was collected through a personal interview; b) the interviewed individuals had at least a two-year experience at the spa; c) for 667 interviewees, a team of properly trained interviewers was used and, for the remaining 165 individuals, the interviews were conducted by employees of the spas. It took more or less 15 minutes to answer each questionnaire. The details of this study are provided in Table 1.

1.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Table 1 | The Study’s Details

Universe

Clients of Spas in Porto and the North of Portugal

Geographical Context

Spas in the North of Portugal

Sample Size

832 Inquiries

Sample Error

3.4%

Confidence Level

95%; Z=1,96; p=q=0.5

Sample Type

Quotas

Information Gathering Method

Personal Interview

Fieldwork Dates

11 August to 22 October 2010

4. Findings and Discussion 4.1. Sample The main socio-demographic characteristics of the sample can be observed in Table 2. It shows that the majority of the interviewees are Portuguese (97.3%), from the northern region (58.9%) and from both sexes (women: 54%; men: 46%). The customer type is between 62 and 77 years old (=62.8 years old; =11.79), married or unmarried couples (78.1%), with primary education (55.1%), retired (46.9%) and with an income below 600 euros (the gross monthly income of the household). Table 2 | Sample Description Variables

Variables

Sex

Marital Status

Single

8.7

Male

Widowed

10.2

Female

Divorced/Separated

2.9

Studies’ level

Married/Unmarried Couples

78.1 %

Primary Education

55.1

Professional Status

Secondary/Technical Education

25.4

Exercises a Profession

Higher Education

19.2

Unemployed

Ages

Housekeeper

1.,9

From 22 to 45

7.3

Retired

46.9

Between 46 and 61

Income

34.2

From 62 to 77

43.6

Less than 600 euros

More than 77

10.2

Between 600 and 1.200

Ages / Average

62.82

From 1.200 to 1.800

11.8

Standard Deviation

11.79

More 1.800 euros

15.6

Residence

39.6 22

Doesn’t know/Doesn’t answer

11 %

Portugal

97.3

Region of Origin

Abroad

2.3

North

58.9

Lisbon

10.4

Algarve

1.2

Centre

23.5

Alentejo

1.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

4.2. Measurement Scale of Perceived Quality - SERVTHERM As stated before, the SERVTHERM scale of perceived service quality was built from scales already validated in previous works (Alén, 2003; Cronin and Taylor, 1992, 1994; Grande et al., 2002; Parasuraman et al., 1985, 1988, 1991; Ramsaran-Fowdar, 2004; Snoj, 1995; Snoj and Mumel, 2002). First, we conducted an exploratory factorial analysis of the main components to determine the SERVTHERM scale’s dimensions. We verified whether the data obtained were adequate for the above-mentioned analysis. Both Bartlet’s Sphericity Test (3,740; p<0.001) and the index of Kaiser-Meyer-Olkin (0.931) showed good adequacy of the data for the main components analysis. To favour the interpretation of the factors, Varimax rotation was used, which is a standard procedure in similar investigations in service quality evaluation (Cronin and Taylor, 1992; Falces et al., 1999). In the first analysis, the 21 attributes of the SERVTHERM scale were included, obtaining 4 factors with values higher than 1 and with a variance explained by those factors of 61.07%. Subsequently, the items in which the communality value was lower than 0.5 were eliminated: The spa’s equipment is modern; When the clients have a problem, the spa solves it; The medicinal and mineral waters of this spa have great quality and are in perfect condition; The collaborators of the spa have a careful and professional look; The spa has a great variety and quantity of treatments; and The services of the spa are provided on schedule. After eliminating these items, we obtained the final solution, which can be observed in Table 3. The main components final analysis shows the existence of 3 factors that explain 60.93% of the total variance, which can be considered acceptable, thus indicating a good summary of the 15 items set in the original scale. The original SERVQUAL scale’s variance ranged between 56% and 61.6%, and the SERVPREF’s scale between 29% and 57.5%. In the work of Babakus and Boller (1992), the variance was 58.3%, and in that of Carman (1990), it was between 61% and 75%; in Alén’s (2003) study applied to the spa sector in Spain, the variance was 55.98%. Table 3 | Exploratory Factorial Analysis of SERVTHERM Item

Com.

The employees of this spa have a good knowledge when dealing with clients (they know the business)

0.775

0.653

The employees of this spa are always willing to help the clients

0.772

0.658

The behaviour of the employees in this spa is friendly and familiar

0.765

0.659

The behaviour of the employees of this spa conveys trust to their clients

0.709

0.63

The clients of this spa always receive personal attention

0.684

0.556

The clients of this spa are accurately informed about the services’ schedules

0.662

0.485

The services provided by the spa are trustworthy

0.638

0.634

The employees of this spa are prepared to answer to your clients

0.63

0.631

The decoration of the spa is simple and welcoming

0.563

0.494

The spa has a very beautiful natural surrounding

0.504

0.312

In the spa there is permanent medical assistance

0.776

0.653

The spa is well located

0.713

0.648

The schedules of this spa are flexible and adapted to the various clients

0.652

0.638

The employees of this spa have the capacity to recognize the clients’ needs

0.788

0.747

The problems of the clients in this spa are always solved.

0.785

0.742

% Variance

46.22

7.98

6.72

1.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Table 3 | Exploratory Factorial Analysis of SERVTHERM (continuation) Item

% Accumulated Variance

46.22

54.2

60.93

Cronbach α

0.901

0.674

0.713

6.933

1.197

1.009

Number of items Eigen values after the rotation

Cronbach α Total (15 items)

Com.

0.908

Average and standard deviation

5.90

5.91

5.85

Standard deviation

0.59

0.83

0.75

The average of each dimension was calculated based on the average of its items. F1 - Professionalism; F2 - Tangible aspects of the Spa; F3 - Empathy.

Regarding the analysis of the scale’s reliability, the Cronbach’s alpha coefficient for the entire client sample was used. The global value of the scale, containing the 15 items, was 0.931, being clearly higher than 0.8, which is recommended by several authors.2 For each of the dimensions, we obtained alphas of 0.901 (professionalism), 0.674 (the spa’s tangible aspects) and 0.713 (empathy), respectively, thus indicating that both the scale and its dimensions can be applied in the evaluation of service quality in spas. The first factor or dimension explains 46.22% of the total variance with a Cronbach’s alpha of 0.901, therefore indicating good internal consistency. This factor is designated collaborators’ professionalism, because it includes aspects such as business knowledge, friendly and familiar behaviour, presenting solutions to the clients’ problems as well as other aspects connected with the spa, like simple and welcoming decoration and location. This factor was also identified in other investigations, namely in the area of tourism (Fick and Ritchie, 1991; Ramsaran-Fowdar, 2004, 2008). The second dimension (which explains 7.98% of the total variance and has a Cronbach’s alpha of 0.674, considered to be satisfactory) was designated as the spa’s tangible aspects, due to the fact that it contains items strictly related to the bathhouse, such as the appropriate location of the spa, the existence of permanent medical assistance and the schedules. The dimension “tangibility” was also detected in other investigations in this area (Fick and Ritchie, 1991; Ramsaran-Fowdar, 2008; Saleh and Ryan, 1991). The third factor explains 6.72% of the total variance with a Cronbach’s alpha of 0.713, again indicating good internal consistency. We call this factor empathy, because it covers two items of the empathy dimension: The problems of the clients in this spa are always solved and The employees of this spa have the capacity to recognize the clients’ needs. In this third factor, as happened for the second one, there is also partial correspondence with the original scale. This fact was also mentioned in other investigations, namely by Fick and Ritchie (1991); Ramsaran-Fowdar (2004, 2008); and Saleh and Ryan (1991). In the analysis of the correlations between the three dimensions, we noticed a positive, moderated and significant correlation between the first dimension (collaborators’ professionalism) and the second dimension (the spa’s tangible aspects) (r = 0.577; n = 346; p < 0.001) and with the third dimension (empathy) (r = 0.597; n = 346; p <0.001). The lowest correlation (r = 0.445; n = 346; p < 0.001) is between the second and the third dimension. The Cronbach’s alpha of the 15 items is 0.908, and this value is identical to the alpha coefficient The recommended Cronbach’s alpha level according to Nunnally (1978): preliminary investigation - 0.7; fundamental investigation – 0.8; and applied investigation - 0.9 to 0.95.

1.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

of the original scale of Cronin and Taylor (1992) and Parasuraman et al. (1988). Considering that the main components analysis previously undertaken is an exploratory technique, its validation will be assured through the confirmatory factorial analysis (CFA), taking into account that we want to prove that a specific construct is formed by a set of dimensions or latent factors. In the confirmatory factorial analysis, three factors were considered, which were obtained from the exploratory factorial analysis. The confirmatory factorial analysis (Figure 2) allowed the verification of the itemsâ&#x20AC;&#x2122; saturation in the factors, considering them as first-rate latent variables and the total scale as second-rate latent variables3. As several authors have suggested, the latent variable or the service quality dimensions must be combined in order to create a single measure to evaluate service quality, thus implying that service quality is itself a latent variable that enhances the other service quality dimensions (Kilbourne et al., 2004). In this context, the evaluation of perceived service quality will be built as a second-rate factor generated from the first-rate factors â&#x20AC;&#x201C; professionalism, tangibility and empathy. Figure 2 contains the final estimates of the second-rate model. It can be pointed out that the global adjustment indexes of the GFI model (0.919), AGFI (0.888) and CFI (0.939) are higher than or at least very close to the recommended figures. In addition, the RMSEA value (0.069) is lower than 0.08. The c2 statistics has a low value (229; gl = 87), which is significant to a trust level of 95%. Figure 2 | Confirmatory factorial analysis

GFI=0.919

AGFI=0.888

CFI=0.939

RMSEA=0.069

c2(87)=229,356

c2g.l.=2

The weights obtained in the CFA were pondered (proportionally according to their relative weight) to reach a total of 1. Therefore, it was possible to assure that the composite measure obtained had a minimum and maximum limit identical to each item, with the same range. 3

1.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

This test analyses the discrepancy between the theoretical model and the reality observed. If a specific model presents a c2 that is statistically significant, the residues generated are significantly different from zero, thus implying that the data differ from the theoretical model tested. However, this result is typically found in large samples. For that reason, some authors (Marsh and Hocevar, 1985) suggest not using this test or performing the analysis together with other indexes (Kahn, 2006). Consequently, the absolute index of c2/g.l. (229/87) was determined, which was considered acceptable. With the data previously presented, it can be stated that the adjustment of the second-rate model is acceptable. The estimated coefficients are all positive and significant to a confidence level of 95%. Therefore, these factors (professionalism, tangibility and empathy) truly represent the concept underlying the perceived service quality evaluation.

5. Conclusions This work allowed the creation of a measurement scale regarding perceived service quality in Portuguese spas, which was designated as SERVTHERM. This scale includes three dimensions: professionalism; the spaâ&#x20AC;&#x2122;s tangible aspects and empathy. Our results identify a group of determinant factors connected with clientsâ&#x20AC;&#x2122; satisfaction in Portuguese spas. Accordingly, spas must have well-prepared employees, who perform their tasks adequately and professionally, while showing some knowledge about the area. Availability, courtesy and individual and familiar attentions towards the clients are also factors that should be considered. The clients have to be informed about the timing and duration of their treatments, and these must be trustworthy. The clients of spas are not simply looking for several types of treatments; they are aiming for the possibility of having direct contact with nature and enjoying a peaceful atmosphere of great natural beauty. The managers of spas should also give special attention to the decoration, to the permanent availability of doctors and to defining flexible schedules, adapted to all sorts of clients. Although placed in the original scale, there are some factors that were not relevant to the clients when they were determining the quality of the various services. Therefore, when considering that the equipment and the quality of the water are not important factors, this can be explained, on one hand, by the effort spas have been making to improve their facilities and equipment and, on the other hand, by the quality and diversity of the thermal waters, namely those in the north of Portugal. The commitment of spas aiming to solve their problems and fulfil the treatmentsâ&#x20AC;&#x2122; deadlines has not been entirely recognized, thus suggesting the inexistence of problems during the service delivery process, which can lead to some depreciation concerning their work. With the development of wellness thermal spas and the consolidation of classical thermalism, a wide range of services has been delivered to clients, which has also contributed to less attention being paid to the great variety and quantity of treatments. The SERVTHERM scale to measure service quality may be useful for the sector for many different reasons: it is an instrument that can be used to improve service quality, because it enhances the positive and negative aspects mentioned by clients. If we determine the specific dimensions of perceived quality in thermalism, then we can define some actions that would be able to improve each one of those dimensions and, consequently,

1.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

the global quality. The scale may be used to compare the quality in different spas, thus allowing the creation of a quality index for this sector. Finally, it is necessary to consider some limitations. The first one is connected with the character of the research, which was applied to the thermal spa sector and to a specific region: the north of Portugal. Consequently, the results obtained cannot be generalized. A second issue is related to the time period of the fieldwork, less than one year, which can lead to differences in the results if we consider other time periods. A third aspect concerns the dimensions obtained. In fact, this three-dimensional model must be tested again, with a new client sample, to analyse its validity. A fourth element refers to the scale validation procedures, due to the use of exploratory and confirmatory factorial analysis of the same sample, without performing cross-validation, i.e., the scale’s validation in different samples. Finally, we can mention the inexistence of relevant literature on service quality evaluation in the thermal sector. In spite of the limitations mentioned above, the SERVTHERM scale may well be used to evaluate service quality in thermal spas in Porto and the north of Portugal, and it should be developed and validated in order to be used on a national scale.

References Alén, G., 2003, Análisis de la calidad de servicios percibida en los estabelecimentos termales: conceptualización, medición y relación con otras variables de marketing, Phd thesis, Universidad Vigo, Spain. Alén, G., Rodríguez, L., 2004, Evaluación de la calidad percibida por los clientes de establecimentos termales a través del análisis de sus expectativas, Revista Galega de Economía, Vol. 13(1/2), 1-18. Babakus, E., Boller, W., 1992, An empirical assessment of the SERVQUAL scale, Journal of Business Research, Vol. 24(3), 253-268. Carman, M., 1990, Consumer perceptions of service quality: An assessment of the SERVQUAL dimensions, Journal of Retailing, Vol. 66(1), 3355. Cronin, J., Taylor, S., 1992, Measuring service quality: A reexamination and extension, Journal of Marketing, Vol. 56(3), 55-131. Cronin, J., Taylor, S., 1994, SERVPERF versus SERVQUAL: Reconciling performance-based and perceptions-minus-expectations measurement of service quality, Journal of Marketing, Vol. 58(3), 125-131. Eraqui, I., 2006, Tourism services quality (TourServQual) in Egypt - The viewpoints of external and internal customers, Benchmarking: An International Journal, Vol. 13(4), 469-492. Falces, D., Sierra, D., Becerra, G., Briñol, T., 1999, HOTELQUAL: Una Escala para medir calidad percibida en servicios de alojamiento, Estudios Turísticos, Vol. 139, 95-110. Fazenda, N., 2008, O turismo da região do Norte de Portugal, Plano Regional de Ordenamento do Território do Norte-PROT-Norte, 1-42. Fick, R., Ritchie, B., 1991, Measuring service quality in the travel and tourism industry, Journal of Travel Research, Vol. 30(2), 2-9. Frochot, I., Hughes, H., 2000, HISTOQUAL: The development of a historic houses assessment scale, Tourism Management, Vol. 21, 157-167. Getty, M., Thompson, N., 1994, The relationship between quality, satisfaction, and recommending behavior in lodging decisions, Journal of Hospitality & Leisure Marketing, Vol. 2(3), 3–22. Ghobadian, A., Séller, S., Jones, M., 1994, Service quality - Concepts and models, The International Journal of Quality & Reliability Management, Vol. 11(9), 43-66. Grande, F., Valejo, M., Moya, D., 2002, Análisis de las expectativas de la oferta y la demanda relativas a la cualidade del servicio en zonas turísticas de interior: implicaciones de gestión, Estudios Turísticos, Vol. 154, 79-112. Kahn, H., 2006, Factor analysis in counseling psychology research, training, and practice: Principles, advances, and applications, The Counseling Psychologist, Vol. 34, 684-718. Kan, M., 2003, ECOSERV – Ecotourists’ quality expectations, Annals of Tourism Research, Vol. 30(1), 109-124. Kandampully, J., 2000, The impact of demand fluctuation on the quality of service: a tourism industry example, Managing Service Quality, Vol. 10(1), 10-18. Kilbourne, W., Duffy, A., Duffy, M., Giarchi, G., 2004, The applicability of SERVQUAL in cross-national measurements of health-care quality, The

1.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Journal of Service Marketing, Vol. 18(7), 524-533. Knutson, B., Stevens, P., Wullaert, C., Patton, M., Yokoyama, F., 1991, LODGSERV: A service quality index for the lodging industry, Hospitality Research Journal, Vol. 14(2), 277-284. Marsh, W., Hocevar, D., 1985, Application of confirmatory factor analysis to the study of self-concept: First and higher order factor models and their invariance across groups, Psychological Bulletin, Vol. 97(3), 562-582. Nunnally, C., 1978, Psychometric theory, McGraw-Hill, New York.

Oliver, L., 1980, A cognitive model of the antecedents and consequences of satisfaction decisions, Journal of Marketing Research, Vol. 17, 460469. Parauraman, A., Zeithaml, V., Berry, L., 1985, A conceptual model of service quality and its implications for future research, Journal of Marketing, Vol. 49(4), 41-50. Parauraman, A., Zeithaml, V., Berry, L., 1988, SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality, Journal of Retailing, Vol. 64(1), 12-40. Parasuraman, A., Berry, L., Zeithaml, V., 1991, Perceived service quality as a customer-based performance measure: An empirical examination of organizational barriers using an extended service quality model, Human Resource Management, Vol. 30(3), 335-364. Parasuraman, A., Zeithaml, V., Berry, L., 1994, A reassessment of expectations as a comparison standard in measuring service quality: Implications for further research, Journal of Marketing, Vol. 58, 111-124. Ramsaran-Fowdar, R., 2004, Identifying health care quality attributes, Journal of Health and Human Services Administration, Vol. 27(3/4), 428-443. Ramsaran-Fowdar, R., 2008, The relative importance of service dimensions in a healthcare setting, International Journal of Health Care, Vol. 21(1), 104-124. Saleh, F., Ryan, C., 1991, Analysing service quality in the hospitality industry using the SERVQUAL model, The Service Industries Journal, Vol. 11(3), 324-345. Silva, J., Mendes, J., Guerreiro, M., 2001, Construção de indicadores de avaliação da qualidade no turismo, Universidade do Algarve, Faro. Snoj, B., 1995, The profiles of importance of service quality components in health spas, Dear Mark, Vol. 34(2), 95-104. Snoj, B., Mumel, D., 2002, The measurement of perceived in service quality - The case of health spas in Slovenia, Journal of Vacation Marketing, Vol. 8(4), 362-379. Stevens, P., Knutson, B., Patton, M., 1995, DISNESERV: A tool for measuring service quality in restaurants, Cornel Hotel and Restaurant Administration Quarterly, Vol. 36(2), 56-60. UNWTO, S.d., http://www.unwto.org/facts/eng./vision.htm (site accessed 22 February 2009). Weiermair, K., 2000, Tourists’ perceptions towards and satisfaction with service quality in the cross-cultural service encounter: Implications for hospitality and tourism management, Managing Service Quality, Vol. 10(6), 397-409.

Author’s Contacts ROSA MARIA RIVEIRO CONDE | rosariveiroconde@gmail.com ANDRÉS MAZAIRA | amazaira@uvigo.es PATRÍCIO RICARDO SOARES COSTA | pcosta@fpce.up.pt

The Importance of Relationship Marketing for Thermal Spas. A Case Study of the Dão-Lafões Region

1.2.

JOAQUIM GONÇALVES ANTUNES

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.2.

Abstract This study centres on the analysis of the different roles performed by the determinants of relationship marketing in satisfaction and customer loyalty in the thermal spa sector. Relationship marketing presents a new paradigm, focussed on building stable and lasting relationships with customers. This contrasts with the traditional approach aimed at promoting transactions. Thermal spas, a health and wellness tourism subproduct and a service of relevant importance in Portuguese tourism, are presenting signs of maturity/decline, hence are challenging marketers to derive new investments and new management approaches. With this research we attempt to establish a set of constructs associated with relational marketing that responds to changes in the attitudes and demands of consumers, focusing on their loyalty. The empirical study is carried out with people who visit the D찾o-Laf천es thermal spas, using a quota sampling process.

Keywords: relationship, marketing, satisfaction, loyalty, thermal spa.

1.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1. Introduction

The development of tourism in recent years and the increasing complexity of markets have brought new concerns to those responsible for tourism organizations. Growing competition from tourist destinations and organizations, both in current products and in the generation of new products, increases the importance of marketing tools. This scenario of uncertainty that tourist destinations are facing has led to new approaches to marketing, of which relationship marketing stands out. Its action is based on customer retention with a high level of service and contact in a long-term vision. Customer value is particularly important, as it seeks to maintain a high level of engagement with the most valued customers. Thermal spas, with their wealth of water resources, their history and their various tourism products, have endured troubled times, with growth rates that have been at times positive and at times negative. Some resorts have been able to create wealth for local populations by attracting investments, businesses, tourists and even residents. Others, however, have been losing out in the realm of hydrotherapy, including all of the development based on that product. It is, therefore, necessary to work out the factors of differentiation and (re)position the product in the face of increasingly demanding markets in order to maintain customers and attract new ones (Antunes, 2011). Research in this field is still scarce in Portugal. Although some research and work related to relationship marketing have been undertaken, their application to spas is still only in the early stages. It is from this perspective that this study emerges. It seeks to study how the tools of relationship marketing have been used to develop spas. The study focuses on the spas in the Dão-Lafões region (in the center of Portugal), as this region has the highest number of spas in the country. The paper is structured as follows: after this introduction, the methodology used to carry out the present research is described in section 2. In section 3, we present the results of the study, starting with a characterization of hydrotherapy in Portugal and, in particular, in the Dão-Lafões region, based on secondary data. Subsequently, we present the results from the empirical research conducted on spa goers in the Dão-Lafões region. Finally, we present our conclusions and some indications for future research.

2. Methodology The methodology for this study was based on a survey of the literature, exploratory interviews with the CEOs of the Dão-Lafões region thermal spas and a structured survey given to the clients of those spas. The construction of observation instruments was thus guided by qualitative and quantitative methods – the methodology proposed by Churchill (1979). Pre-tests were conducted on a reduced sample to finetune the measuring instrument. This sample was based on over-18-year-old spa goers in the region under study.1 The sample included 150 surveys, which were validated for analysis, representing a margin of error of 7.9% for a confidence level of 95%. The sampling process was built on interrelated quota sampling, based on the proportions of spa frequency and the gender variable. The data were processed using the SPSS (Statistical Package for Social Sciences) version 17.0. 1

Spa goers of the Caldas da Cavaca spa were not surveyed as this spa was closed for renovation and only reopened recently.

1.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Through the empirical study, we sought to analyse the relationship between the variables of relationship marketing and its influence on spa goers’ satisfaction and loyalty. To this end, certain hypotheses were considered, which will be tested by linear regression. The survey of the literature shows that relationship marketing has been operationalized in different ways. In this study, we will consider the “understanding needs,” “quality of service” and “customizing services” sub-constructs because they are considered the most important variables for the satisfaction and loyalty of spa goers (Figure 1). Figure 1 | Effects of Relationship Marketing on the Satisfaction and Loyalty of Spa Goers. Relationship marketing constructs

Understanding needs

Quality of service Customizing services

H1 H2

Satisfaction of spa patrons

Loyalty of spa patrons

Relationship marketing is based on the idea that working with customers on a basis of mutual trust facilitates the development of long-term relationships. Therefore, it is necessary for spa organizations to know their customers and seek direct contact with them (Antunes and Rita, 2007). To this end, spa organizations should seek to identify their customers better and to develop individual and relevant relationships in order to determine their attitudes and changing needs and thus influence their loyalty. An organization should try to ensure, through its policies and strategies, that its customers have an appropriate level of satisfaction in line with their initial expectations. Fornell’s (1992) research confirms the fact that customer satisfaction is a function of the customer’s expectations and perceived performance with regard to the product or service offered by the organization. The idea of collaborating with customers in striving to meet their needs to a greater extent on the basis of mutual trust, which facilitates the development of long-term relationships, is an extremely important factor for any organization. It requires organizations to know their customers and seek direct contact with them. Understanding customers’ expectations and needs involves organizations’ ability to identify customers’ needs and provide services at the expected level. Understanding customers’ needs is one of the dimensions relating to satisfaction used in Evans and Laskin’s (1994) study. Given these considerations, we can establish the following hypothesis:

H1: Understanding the needs of spa goers has a positive relationship with their satisfaction. Companies seeking to advance a business development strategy should devote most of their efforts to ensuring that their customers understand that they offer quality in their services, since this is an important and necessary input to achieve customer satisfaction. Before purchasing a product or service, customers will form certain expectations about what they think they

1.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

will receive and then compare these expectations with their perceived outcome. Customers will be satisfied when they receive at least what they expected from their supplier and dissatisfied when the result of purchasing the product or service is lower than expected. Service quality is an antecedent to customer satisfaction (Zeithaml, Berry and Parasuraman, 1996). Given these considerations, we can establish the following hypothesis:

H2: Service quality has a positive relationship with spa goer satisfaction. Companies will have to exceed monitoring their customers and interacting with each of them. They must be willing to adapt their products and services to each of them. Evolving technologies allow greater customization of products and services and communication with each customer. Today, customization is an important way to value products, and for a large amount of products and services, mass customization is beginning to be possible (Peppers and Rogers, 1997; Reis, 2000). On the other hand, customization will increase customer satisfaction (Mittal and Lassar, 1996; Peppers, Rogers and Dorf, 1999). We propose the following hypothesis with these theoretical considerations in mind:

H3: Customization has a positive relationship with spa goer satisfaction. Loyalty is now considered the key element of relationship marketing. However, customer satisfaction precedes loyalty (Chow and Holden, 1997; Filser, 2001). Thus, spa managers should seek to satisfy their clients, since satisfied customers are usually loyal customers. This, in turn, enhances their relationship with the organization by increasing the value of acquisitions and recommendations to other potential customers (word of mouth), which expands the portfolio of customers (Grönroos, 2004; Palmatier et al., 2006). These factors contribute to improvements in the spa’s revenue and profitability. We propose the following hypothesis, taking into account these theoretical considerations:

H4: Satisfaction has a positive relationship with spa goer loyalty. We use linear regression to test these hypotheses, based on the factors resulting from principal components factor analysis, performed on the different items in each measurement scale of the model’s constructs. We use a 7-point Likert scale (from 1 – strongly disagree – to 7 – strongly agree) to measure each item. The scales have been validated through their psychometric properties: reliability and unidimensionality.

3. Results We begin this section with a characterization of hydrotherapy in Portugal based on secondary data. This analysis will allow the importance and relevance of this tourism product in the interior regions of the country to be better understood. Then, the Dão-Lafões region is characterized in terms of thermal spa frequency and growth prospects. Subsequently, the results of the empirical study are presented.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.2.

3.1. Thermalism in Portugal Thermal springs, as part of health and wellness tourism,2 contribute to attenuating regional disparities and imbalances due to their location mainly in the interior of the country, because of the jobs generated by the activities they entail and the flux of tourists they attract. However, the demand for spas has shown very irregular values over the past few years. As shown in Table 1, the spa demand between 2000 and 2010 fluctuated between negative and positive growth rates. After a period of positive growth rates between 2000 and 2002, during which it was thought that hydrotherapy would finally start to move towards the long-desired levels, during the past seven years it has shown negative growth rates again, falling from 95,586 enrolments in 2002 to 69,735 in 2009. The latest figures, relating to 2010, show more satisfactory values, with growth of 6.8%. Regarding the analysis of revenue, the situation is totally different. Although there are fewer spa goers, the total revenue has grown almost every year. This may mean that either prices have increased from year to year or the number of prescribed services for each customer has increased. Another analysis that can be performed is related to the average revenue per spa goer, which is the ratio between the amount of revenue and the number of spa goers. In fact, the average revenue per spa goer has grown significantly over all of the years analysed in this series, except 2008. Table 1 | Spa Goers and Revenue at Spas Between 2000 and 2010 No. of enrollments Year

Revenue

Spa goers

Var. (%)

103 €

Var. (%)

Average revenue per spa goer €

2000

85,226

2,01

12,268

13.57

143.9

2001

93,186

9,34

13,684

11.54

146.8

2002

95,586

2,58

16,136

17.92

168.8

2003

91,757

-4,01

16,110

-0.16

175.6

2004

89,827

-2,1

17,893

11.1

199.2

2005

85,841

-4,44

18,036

0.78

210.1

2006

80,508

-6,21

18,437

2.22

229

2007

80,018

-0,61

18,892

2.47

236.1

2008

74,074

-7,43

16,007

-15.27

216.1

2009

69,735

-5,86

16,897

5.56

242.3

2010

73,387

6,8

17,842

5.6

243.1

Source: TP (2011), Data treated by the author.

In analysing the ranking of spas in Portugal based on the number of enrolments, what greatly stands out, on the one hand, is the spa of S. Pedro do Sul, with 19,523 enrolments in 2010, and on the other hand, the number of spas with a low level of enrolments. Regarding S. Pedro do Sul, it has maintained its leadership far ahead of the others for several decades (Table 2).

Health and wellness tourism based on natural mineral waters includes thermalism and thalassotherapy. Only thermalism is considered in this study since only this product exists in the Dão-Lafões region.

1.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Table 2 | Ranking by Enrollments in Classic Thermalism - 2010

Ranking

Thermal spas

Spa goers

Revenue [103 €]

Average revenue [€]

S. Pedro do Sul

19,523

5,318

272.4

Caldas de Chaves

6,546

1,099

167.9

Monfortinho

4,716

662

140.4

Termas do Carvalhal

3,770

521

138.2

Caldelas

3,484

817

234.5

Felgueira

3,280

1,256

382.9

Caldas de S. Jorge

3,219

719

223.4

Termas do Gerês

3,080

512

166.2

Banho de Alcafache

2,757

627

227.4

Sulfúrea

2,360

543

230.1

Monte Real

2,238

394

176.1

Curia

1,807

582

322.1

Caldas da Rainha

1,632

433

265.3

Caldas da Saúde

1,499

442

294.9

Termas de S. Vicente

1,470

1,009

686.4

Caldas de Sangemil

1,185

296

249.8

Caldas de Manteigas

1,026

241

234.9

Termas da Longroiva

936

143

152.8

Fadagosa de Nisa

917

281

306.4

Caldas de Aregos

866

228

263.3

Unhais da Serra

830

200

241

Caldas da Cavaca

797

134

168.1

Termas de Entre-os-Rios

748

176

235.3

Termas do Luso

679

228

335.8

Caldas do Cró

636

135.2

Termas de Almeida

618

115

186.1

Caldas de Monchique

543

341

628

Caldas das Taipas

516

123

238.4

Termas da Ladeira de Envendo

444

119

268

Caldas de Monção

414

19.3

Termas do Vimeiro

348

264.4

Caldas do Carlão

229

240.2

Termas do Estoril

119

210.1

Termas do Vale da Mó

104

67.3

Termas de Vidago

107.1

Pedras Salgadas

304.3

73,387

17,842

243.1

Total

Source: TP (2011)

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.2.

However, in recent times, a new concept of thermalism has been advanced, called health and wellness thermalism. Legislation has come into force authorizing this new modality by Decree-Law no. 142/2004 of 11 June. This new concept is characterized by combining the traditional concept of thermal treatment with another set of offerings focussed on wellness thermalism, with a greater emphasis on leisure, beauty and aesthetics, and relaxation. This new concept, which is sought in thermal spas, is allowing the product of the resort to be defined as a global tourism product, able to offer services complemented by thermal and non-thermal products that surpass the traditional concept of spas, to convert them into modern tourist centres through a more diverse offering and clientele. The values shown in Chart 1 allow us to affirm the growing demand for this new philosophy. The demand for wellness thermalism has been increasing gradually, in contrast to that for classic thermalism, which has decreased every year except 2010. Chart 1 | Motivation for Thermal Spa Resort Demand in Portugal Between 2003 and 2010

100000 80000 60000

Clássico

40000

Bem-estar

20000 0 2003 2004 2005 2006 2007 2008 2009 2010 Source: TP (2011)

In fact, in recent years, new perspectives have arisen for Portuguese thermalism. The renovation of much of the infrastructure has enabled many spas to revitalize thermalism, both in terms of its therapeutic characteristics and as tourist centres. Actually, nowadays there is a new group of people looking for a spa for a restful vacation involving close contact with nature while at the same time enjoying services oriented towards caring for the body (weight loss, skin care, anti-stress, etc.): a set of services that lies at the border between medicine, aesthetics, sports and leisure (Ferreira, 1995). Therefore, it is necessary to seize these market opportunities and develop strategies to attract a clientele with potential for added interest. Thus, based on articulating both vocations – therapeutic and leisure – thermalism seems to be a high-potential tourist resource (Monbrison-Fouchère, 1996). However, it is necessary to take advantage of the proliferation of new trends in ownership of these places by offering new services capable of responding to the stress caused by modern life. Another perspective in analysing the situation of Portuguese thermalism is to compare the percentage of people who visit thermal spas in various European Union countries. Thus, as shown in Chart 2, only 0.9% of the population enjoys Portuguese thermalism, compared with, for example, 6.5% in Switzerland, 9.6% in Finland or 11.5% in Germany.

1.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Chart 2 | The Demand for Thermal Spas in Some European Countries as a Percentage of the Population, in 2006

Polónia Áustria Alemanha Portugal

Suíça

Finlândia Espanha França Itália 0

Source: ESPA (2007)

Despite the low percentage of the Portuguese population who choose spas, there are some relatively important Portuguese resorts, as is the case of several in the Dão-Lafões region, as we will examine below.

3.2. Thermalism in the Dão-Lafões Region The Dão-Lafões region is situated in the central region of Portugal and consists mostly of municipalities in the district of Viseu and includes one municipality of the district of Guarda – Aguiar da Beira. This region is bounded on the north by the Tâmega River and the Douro River. To the east, its boundary extends to the Beira Interior Norte and the Serra da Estrela mountains and to the south it is bounded by the Pinhal Interior Norte and the Lower Mondego. To the west, the Lower Vouga and Entre Douro e Vouga are its boundaries. Its area is 3,483 km2 and its population in 2006 was 291,017 inhabitants. Figure 2 – Map of the Dão-Lafões Region

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.2.

All thermal spas listed in Table 3 are in operation in the Dão-Lafões region. However, the activities at Caldas da Cavaca were suspended for over 15 years for renovation and it only reopened recently. From this Table 3 we can see that the 6 spas in the Dão-Lafões region represent a market share of 42.67% of the national total in terms of the number of spa goers and 45.69% of the revenues. Therefore, these results clearly show the importance of this activity in this region. Of the top 10 national spas, 4 are in the Dão-Lafões region. The thermal resort in the country – S. Pedro do Sul – has a market share of 26.6% in terms of the number of enrolments and 29.81% of the revenues.

Table 3 | Thermal spas in the Dão-Lafões region, in 2010 RANK

SPA

ENROLMENTS

VALUE

No.

Market share

€ 103

Market share

Average revenue per spa goer

S. Pedro do Sul

19,523

26.60%

5,318

29.81%

272.4

Termas do Carvalhal

3770

5.14%

521

2.92%

138.2

Felgueira

3280

4.47%

1,256

7.04%

382.9

Banho de Alcafache

2757

3.76%

627

3.51%

227.4

Caldas de Sangemil

1185

1.61%

296

1.66%

249.8

Caldas da Cavaca

797

1.09%

134

0.75%

168.1

31,312

42.67%

8,152

45.69%

260.3

Total da Região Dão-Lafões

Source: TP (2011)

If we compare the average value of the revenue of the entire region (€260.30) with the average total national value (€243), we find that the value of the Dão-Lafões region is significantly higher. This analysis demonstrates that the market share that the region has cannot be due to the fact that it has low prices; rather, its prices are much higher than the national average. We can even find that the resort at Caldas da Felgueira presents the highest average revenue per spa goer nationally. Thermalism thus assumes significant importance in the Dão-Lafões region and is recognized as one of the tourism products with huge potential for the utilization of the region’s indigenous resources. Due to their location, these resorts can play an important role as a factor in developing tourism in the interior, contributing to mitigating regional disparities (Cavaco, 1980). To gain a better understanding of the importance of this sector in the region, an empirical study was carried out with those responsible for the region’s spas and their spa goers. Its methodology has been described above and the results are presented in the following section.

3.3. Results of the Empirical Study The results of the study carried out at the spas in operation at the time of information collecting in the DãoLafões region were based on a sample of 150 spa goers, in proportion with the number of enrolments in previous years and gender, in this way attempting to obtain a degree of representativeness of the population (Table 4).

1.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Table 4 | Number of People Surveyed per Spa

Spa

No. of people surveyed

Percentage

Alcafache

Carvalhal

6.6

C. Felgueira

16.7

S. Pedro Sul

64.7

Sangemil

Total

150

100

Source: Spa patron survey

Regarding the characterization of the sample in terms of demographic variables (Table 5), it appears that the spa-goers are mostly female (62.7%) and represent a very aged population, of which 40% are over 65 years in age and 75.3% are aged over 55 years. Their qualifications are mostly at the level of basic education (43.4%). Table 5 | Distribution of Spa Goers by Demographic Variables Sample total

Demographic variables

Gender

Age

Academic Qualifications

Frequency

% valid

Male Female

56 94

37.3 62.7

Total

150

100

18-24 25-34 35-44 45-54 55-64 65-74 ≥75 N/R

2 4 10 20 53 46 14 1

1.3 2.7 6.7 13.4 35.6 30.9 9.4 -

Total

150

100

Basic Education Secondary Education Average Level Course Higher Education Did not answer

62 25 31 25 7

43.4 17.5 21.7 17.5 -

Total

150

100

Source: Spa patron survey

In the following analysis, we will test and validate the hypotheses set forth. We will use linear regression to determine whether the variables are related and whether the type of relationship is positive or negative. This technique assumes residual analysis resulting from the difference between the values estimated by the regression and the observed values. We start by testing hypothesis 1. In the linear regression model, we consider the satisfaction factor as the dependent variable and the understanding needs factor as the independent variable. The determination coefficient (R2) has a value of 0.602, which represents a good fit of the model with regard to the data. The variance analysis of the model through the Snedecor F test also shows satisfactory values (F = 222.235 with an associated significance level of 0.000).

1.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Table 6 presents the linear regression coefficients. The coefficient of the independent variable (the understanding the needs factor) shows a positive value of 0.778. This value is statistically significant (t = 14.908 and sig. = 0.000), which leads to the acceptance of hypothesis H1: Understanding the needs of spa goers has a positive relationship with their satisfaction. Table 6 | Linear Regression Coefficients (H1)a Unstandardized Coefficients

Standardized Coefficients

Std. Error

Beta

(Constant)

-.002

.052

Needs Factor

.778

.052

Model

.776

Sig.

39 -.046

.964

14.908

.000

a. Dependent Variable: Satisfaction Factor

However, it is necessary to analyse the assumptions of the linear regression model for the correct application. The assumptions are: the residuals are random variables with a zero mean, the residuals have a constant variance, the residuals are not correlated and the residuals are normally distributed. The autocorrelation of the residuals is analysed using the Durbin-Watson test. The normal distribution of the residuals is analysed using graphical histograms and a normal P-P plot. As for the equality of variances, this can be verified by a scatterplot graph in which we have a standardized predicted value as an independent variable and a standardized residual as a dependent variable, for which we analyse whether the variability of residuals over the predicted values â&#x20AC;&#x2039;â&#x20AC;&#x2039;is more or less constant. Therefore, in relation to this modelâ&#x20AC;&#x2122;s assumptions, analysed through the residuals, it appears that these fit into a normal distribution with a zero mean and constant variance. There is also independence of residuals in this case since the Durbin-Watson3 statistic has a value of 1.736. To test hypothesis H2, let us consider the quality of service factor as an independent variable resulting from factorial analysis. The results of the model have a determination coefficient (R2) with a value of 0.544, which represents a good fit of the model with regard to the data. The Snedecor F test has a value of 175.112 with a significance level of 0.000, that is, it indicates a significant linear relationship between the dependent variable of the model and the independent variable. The linear regression coefficient (Table 7) is statistically significant. The t-test has a value of 13.233 (p = 0.000). Table 7 | Linear Regression Coefficients (H2)a Unstandardized Coefficients

Standardized Coefficients

Std. Error

Beta

(Constant)

.006

.056

Quality Factor

.738

.056

Model

.737

Sig.

.11

.913

13.233

.000

a. Dependent Variable: Satisfaction Factor

The Durbin-Watson statistic oscillates between 0 and 4. A value close to 0 means that there is a positive autocorrelation; when the value is close to 4, there is a negative autocorrelation; if the value is close to 2, there is no autocorrelation.

1.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Based on the results described above, we accept hypothesis H2: Service quality has a positive relationship with spa goer satisfaction. Here as well the residuals are independent with a Durbin-Watson statistic of 2.045.

The linear regression results of the model to test hypothesis H3 are also satisfactory. The determination coefficient (R2 = 0.557) and F test (186.216, p = 0.000) indicate that there is a significant linear relationship between spa goer satisfaction and customization of services. The regression coefficient is Ă&#x; = 0.746 and the t-test = 13.646 (p = 0.000), as shown in Table 8. Table 8 | Linear Regression Coefficients (H3)a Unstandardized Coefficients

Standardized Coefficients

Std. Error

Beta

(Constant)

9.45E-17

.055

Customization Factor

.746

.055

Model

.746

Sig.

.000

1.000

13.646

.000

a. Dependent Variable: Satisfaction Factor

The residuals are independent (Durbin-Watson = 1.954) and have a normal distribution with a zero mean and constant variance. These results lead us to accept hypothesis H3: Customization has a positive relationship with spa goer satisfaction. Finally, in testing hypothesis H4, the results of the linear regression model also show satisfactory values. The determination coefficient (R2 = 0.860) and F test (417.008, p = 0.000) indicate that there is a significant linear relationship between satisfaction and spa goer loyalty. The regression coefficient is Ă&#x; = 0.857 and the t-test = 20.421 (p = 0.000), as shown in Table 9. Table 9 | Linear Regression Coefficients (H4)a Unstandardized Coefficients

Standardized Coefficients

Std. Error

Beta

(Constant)

.001

.042

Satisfaction Factor

.857

.042

Model

.86

Sig.

.022

.982

20.421

.000

a. Dependent Variable: Satisfaction Factor

The residuals are independent (Durbin-Watson = 1.586) and have a normal distribution with a zero mean and constant variance. The results described above lead us to accept hypothesis H4: Satisfaction has a positive relationship with spa goer loyalty.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.2.

4. Conclusions Thermalism seems to be a tourist resource with great potential for the DĂŁo-LafĂľes region, not only due to its curative aspect, but also in terms of tourism. In fact, today, this product is becoming increasingly important because of new concerns people have stemming from the lifestyles in modern societies. These concerns have given rise to a demand for new services aimed at revitalizing the physical and mental balance as well as beauty treatments for the body. Nevertheless, some spas in the region still have difficulties in meeting these new demands. It is necessary to revitalize some spas, either by offering new products, in terms of prevention and therapy, or by creating appropriate infrastructures for health, catering, entertainment and leisure in order to meet the market demands. In this sense, a radical change in the regional thermalismâ&#x20AC;&#x2122;s philosophy is urgent. There is a need to convert and remodel the equipment in some spas, along with the need to change and modernize the existing marketing techniques with an emphasis on relationship marketing with the aim of achieving customer loyalty. In this study, we have found that it is necessary for organizations to know and understand the needs of spa-goers so that they can provide service quality in a customized manner and thus improve customer satisfaction. Knowing the needs of each group of spa goers allows the features that are most important to each group to be appreciated and services that are more tailored to their real needs to be offered. We also found that understanding spa goer needs, customizing services and quality have a direct and positive relationship with satisfaction. Therefore, these actions should be taken into account in the development of (new) services. Thermal organizations should also develop a set of activities or loyalty programmes in order to encourage customers to increase the regularity of their visits and, if possible, undergo treatment more than once a year, which would consequently contribute to reducing the strong seasonality that is felt in the sector. In addition, they should seek to develop events to encourage short breaks and weekend visits during periods outside the peak season. Nevertheless, these measures should be combined with a repositioning of the image that non-spa-goers have of Portuguese thermalism. It is necessary to convey an image based on the new services to new consumers.

1.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

References Antunes, J., 2011, “A importância do marketing territorial no (re)posicionamento de uma estância termal. O caso de S. Pedro do Sul”, Actas do 17º Congresso da Associação Portuguesa para o Desenvolvimento Regional, Instituto Politécnico de Bragança, Bragança - Zamora. Antunes, J., Rita, P., 2007, O marketing relacional e a fidelização de clientes – Estudo aplicado ao termalismo português, Revista Economia Global e Gestão, Vol. XII, No. 2, 109-129. Cavaco, C., 1980, “O turismo em Portugal: aspectos evolutivos e espaciais”, in Estudos Italianos em Portugal, Lisboa,191-234.

Chow, S., Holden, R., 1997, Toward an understanding of loyalty: The moderating role of trust, Journal of Managerial Issues, Vol. 9 (3), 275-298. Churchill G., 1979, A paradigm for developing better measures of marketing constructs, Journal of Marketing Research, Vol. 16 (1), 64-73. ESPA – European Spas Association, 2007, http://www.espa-ehv.com/. Evans, J., R. Laskin, 1994, The relationship marketing process: A conceptualization and application, Industrial Marketing Management, Vol. 23, 439-452. Ferreira, C., 1995, Estilos de vida, práticas e representações sociais dos termalistas. O caso das Termas da Curia, Revista Crítica de Ciências Sociais, 43, 93-122. Filser, M., 2001, Le Magasin Amiral: De l’atmosphère du point de vente à la stratégie relationnelle de l’enseigne, Décisions Marketing, Vol. 24, 7-16. Fornell, C., 1992, A national customer satisfaction barometer: The Swedish experience, Journal of Marketing, Vol. 56 (1), 6-21. Gronroos, C., 2004, The relationship marketing process: communication, interaction, dialogue, value, Journal of Business & Industrial Marketing, Vol. 19 (2), 99-113. Mittal, B., Lassar, W., 1996, The role of personalization in service encounters, Journal of Retailing, Vol. 72 (1), 95-109. Monbrison-Fouchère, P., 1995, Le tourisme de santé: définitions et problématique, Cahier Espaces, 43, 12-16. Palmatier, R., Dant, R., Grewal, D., Evans, K., 2006, Factors influencing the effectiveness of relationship marketing: A meta-analysis, Journal of Marketing, Vol. 70, 136–153. Peppers, D., Rogers, M., Dorf, B., 1999, The One to One Fieldbook, Doubleday, New York. Peppers, D. and Rogers, M., 1997, The One to One Future: Building Relationships One Customer at a Time, Doubleday, New York. Reis, J., 2000, O Marketing Personalizado e as Tecnologias de Informação, Edições Centro Atlântico, Lisboa. Turismo de Portugal, 2011, Termas em Portugal – A oferta e a procura em 2010, Direcção de Estudos e Planeamento Estratégico/Departamento de Informação Estatística, Lisboa. Zeithaml, V., Berry, L., Parasuraman, A., 1996, The behavioral consequences of service quality, Journal of Marketing, Vol. 60 (2), 31-46.

Author’s Contact JOAQUIM GONÇALVES ANTUNES | Polytechnic Institute of Viseu [jantunes@estv.ipv.pt]

Mature Spa Travellers in Taiwan

1.3. MEI-TING HSIEH * TIMOTHY JEONGLYEOL LEE **

* Lecturer, Lunghwa University of Science and Technology. ** PhD, Ritsumeikan Asia Pacific University (Tourism and Hospitality Management).

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Abstract In 2009, Taiwanese people who were aged 65 years or older represented 11% of the total population. This percentage is likely to reach 20% by 2025 and 39% by 2051. From 2010, the number of people reaching retirement age will continually increase in Taiwan. These mature, retired people have much more free time than when they were working and start to become concerned about their long-term health status. This study examines how the needs of mature Taiwanese travellers affect their motivation to choose spa destinations and the extent of the demand for spas by this particular group. A questionnaire survey was carried out at spa destinations and 200 valid responses were obtained. A factor analysis of the motivation factors revealed three underlying spa destination attributes and four underlying socio-psychological dimensions. The main spa travel motivations of Taiwanese people were ‘personal health and building relationships’ and ‘commercial internal’, which appeared to be the most important push and pull motivations, respectively. The study also suggests that there is a significant relationship between travel motivation and age group effect on the destination choice. Based on the results, the findings have spa marketing implications and inform other relevant organisations.

Key words: mature traveller, destination choice, spa tourism, Taiwan.

1.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Introduction With the rapid growth of the ageing population, baby boomers now comprise a large proportion of the world travel market. The age cohort category of 55 year olds is starting to reach retirement, and the number in this cohort will continue to increase in Taiwan. Mature people today are likely to have sufficient savings, ample time and more motivation to enjoy themselves, spend money more freely on activities and concentrate more on their personal health. Particularly in the health tourism industry, marketers have started to focus on differentiating segments of the mature age groups (Moschis, Lee, and Mathur, 1997). The growth of hot spring tourism since the 1900s is well recognised in Taiwanese society. Natural springs have been acknowledged for centuries as having specific medicinal benefits for improving people’s health. Since 1999, due to the Taiwanese Government’s promotion of the benefits of spa activities1, visitors have been increasingly seeking a healthier lifestyle to maintain their wellness. The spa tourism sector would seem to be one of the pioneer ‘value sectors’ during the modernisation process of Taiwan. The number of spa destinations has increased markedly and they attract people through a range of diverse products. Moreover, these products have tapped into rapidly expanding markets, which include sectors such as health-care services and the medical wellness industry. People travel to spa resorts and destinations for a broad range of reasons including socialising and improving well-being and for physical therapy. People also visit them as part of a quest for spiritual enlightenment and to develop a healthy lifestyle. Hence, to tailor facilities, products and services to particular groups’ needs, upgrading the quality of spa destinations is important for market segmentation. Research has paid limited attention to mature travellers and the mode of spa destination choice. It is vital to be aware that mature travellers’ needs are now more diverse and multifaceted than ever, and this highlights the need for innovation to meet the demand for a variety of recreational activities.

2. Characteristics of Mature Spa Travellers Taiwan has over 128 natural spring destinations located in different geological areas including plains, mountains, valleys, and oceans (Tourism Bureau of Taiwan, 2004). The survey identified different types of spring (i.e. hot springs, cold springs, mud springs, and seabed springs) with different destination attributes based on water temperature, geology, and chemistry. As springs have multiple curative functions and medical benefits, they have gained popularity among people wishing to ‘take the water’, particularly aged people and patients. Travelling to mineral springs has therefore become one of the most popular recreational activities in Taiwan. 1 This chapter focuses for the most part on (hot) spring tourism, which in other chapters is called thermal tourism or mineral spring tourism, indicating that it makes use of natural mineral water. It also mentions “plain” spa tourism, referring to businesses offering treatments on the basis of tap water. In order to make it easier for the reader, the editing commission systemically simplified the identification of both types of spa in Taiwan by using the term “spas” instead of, for example, “spring/spa tourism” or “(mineral spring) spa tourism”.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.3.

This vogue has beneficial effects for the relevant industries, not only for the health-related tourism industry but also for medical treatments, the social insurance system, and the national economy. The majority of health spa tourism in Taiwan is domestic, with the total number of visitors increasing from approximately 4 million in 2002 to 15 million people in 2004. They visit hot springs to experience their therapeutic techniques and leisure activities (Tourism Bureau of Taiwan, 2004). Nowadays, people travelling for their health to spa resorts and destinations are an attractive phenomenon. In particular, new health spa destinations have revived the health tourism market. The features and attractions of the spas draw people to particular destinations. Health and spa tourism has been booming in Taiwan since the Government implemented the ‘Taiwan hot spring tourism year’ in 1999. As part of this promotion, the Taiwan Tourism Bureau allied with spring festivals to help revive the health spa industry. Following such promotions, it is not surprising to see health spa destinations discussed in the mass media. Health spa tourism is not only an important curative activity for domestic tourists, but is also of interest to overseas tourists. This potential growth area is crucial to the Taiwanese tourism industry. With society’s transformation, a number of sociologists recognise that leisure activities may create a new lifestyle to re-energise mature travellers. The new aged sector has different needs in terms of attitudes and quality of leisure. Thus, different approaches are needed with respect to the ways to travel and the time spent. Norman, et al. (2001) refer to the mature market as a complex phenomenon in which there is an interaction of biological, psychological, historical and social factors. This means that the characteristics of mature travellers are responsive to various activities. As people today have more opportunities to arrange their working hours and leisure time, and the life expectancy continues to rise, many people are engaging in more physical activities. Although the reasons for participating in spa travel are to socialise, improve well-being, and undergo physical therapy, there is a new sense in the quest for improved health that includes a spiritual aspect. It is important to be aware that mature travellers’ needs are more diverse and multifaceted than ever, and this highlights the need for innovation to meet the demand for a variety of recreational activities.

3. Methodology and Data Collection A survey was undertaken with mature spa travellers visiting natural springs in Taiwan. The study was also designed to extend the theoretical framework for Taiwanese mature spa travellers. This design was chosen because it provides a snapshot picture of the phenomenon under study. The questionnaire was developed based on a relevant literature review, conversations with mature spa travellers, and a pilot survey. The questionnaire considered the information that would be essential to the respondents’ understanding of the destination attributes of spas. Structured questions were used to gather information on natural spa attributes and socio-demographics. The sample was randomly selected from spa travellers who had an interest in staying at and visiting spa destinations for particular purposes, such as health, activities, or experiencing a nature-based environment. The empirical evidence for the relationship between motivation and destination choice is investigated in order to determine what those factors may mean for particular spa groups, government policy reform, and market management. The data for this research were collected from 33 spa destinations with 15 different geological natural spring formations in the cold spring region of Taiwan. The data collection phase was conducted over a period of 7 months beginning in October 2007. The questions on the destination attributes use internal and external

1.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

forces to represent intrinsic and extrinsic factors. They contain the real reason for visiting, companions, and geographical characteristics of the health spa destination. A total of 285 mature spa travellers were invited to fill in the questionnaire at destinations after they had visited or stayed in the spa. An analysis of the numerical data was followed by data entry using 200 valid responses.

Accordingly, the statistical method of analysis involved summaries of the broad descriptive statistics to describe mature spa travellersâ&#x20AC;&#x2122; characteristics related to motivation and how the destination features influenced spa tourism experiences. Following this, the study used the exploratory factor approach as an analysis technique to explain traveller motivations and to explore whether there are differences between demographics and destination choice. A principal component factor analysis was used to examine the importance of push and pull motivation factors within the spa travel groups and whether there were differences in terms of destination attributes. Subsequently, the analysis proceeded to investigate whether there is a significant difference in the socio-psychological characteristics and demographic variables that influence mature spa travellers to visit a certain destination. The variables consist of demographic traits, the trip purpose, the characteristics of the trip, and the socio-psychological factors. A factor analysis of the motivation factors revealed three underlying spa destination attributes: commercial internal; commercial external; natural and friendly service. An ANOVA analysis revealed that the main effects of age groups on destination choice are significant. The study proceeded to establish whether variations in these factors have an effect on the choice of Taiwanese mature travellers as measured in the study. The findings will have spa marketing implications in conjunction with influences on the theoretical framework.

4. Data Analysis and Discussion A principal component analysis was carried out to investigate the importance of push and pull factors within the Taiwanese mature travel groups, the underlying motivations of travellers, and the differences in terms of destination attributes. An independent samples T-test was conducted to compare the difference between the means of two groups, such as the mean push factors of male and female travellers in mineral spring destinations or whether there are any significant differences between two means according to the demographic characteristics.

a. Demographic Profile A summary of the demographic characteristics examined is shown below in Table 1. The sample was composed of 200 mature traveller respondents from health spa destinations. It shows that 61.5% of the respondents were males and 38.5% were females; the majority of the mature travellers to spas were male. Regarding age, 42.5% of the respondents were aged between 50 and 54, and only 27.5% were over 60 years old, with a mean of 57.1. Overall, the sample of Taiwanese spa mature travellers was less highly educated than a college or university degree. Of the respondents, 34.5% reported that they are retired and the others stated their occupation as business owner. White-collar worker (31.5%) was the most common occupation of the respondents. When considering aspects of individual health status, most of the Taiwanese mature travellers generally replied that they perceive their own health to be good (50%) or excellent (15.5%). Only 3% of the mature travellers felt that they have some health problems, and 6.5% of them felt that they have poor health (either physical or mental health in their daily living, including disease, impairment, disability, and handicap).

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.3.

Table 1 | Travellersâ&#x20AC;&#x2122; Demographic Profile Mature travellers (N=200) Frequency (%) Gender Female

77 (38.5)

Male

123 (61.5)

Education Under college level

130 (65)

College above level

68 (34)

Income Under NT$210,000

28 (14)

NT$10,001-NT$20,000

26 (13)

NT$20,001-NT$30,000

38 (19)

NT$30,001-NT$40,000

42 (21)

NT$40,001-NT$50,000

28 (14)

NT$50,001 and over

37 (18.5)

Health Bad

6 (3)

Poor

13 (6.5)

Fair

50 (25)

Good

100 (50)

Excellent

31 (15.5)

Occupation Blue-collar worker

47 (23.5)

White-collar worker

63 (31.5)

Professional

21 (10.5)

Retired and Others

69 (34.5)

1.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

b. Travel Behaviour

The result for travel behaviour shows that nearly 77% of the respondents tend to visit a spa destination more than once each year, whereas the remaining respondents visit spa destinations only annually. The vast majority of the respondents (about 77%) have visited spa destinations more than once before, whereas the rest were visiting spa destinations for the first time. This result indicates that Taiwanese mature travellers have experience in purchasing spa products. The majority of the respondents indicated that they usually visit spa destinations for a day or stay for only one night at these destinations. This suggests that mature travellers in Taiwan generally stay for a very short time at spa destinations. Nearly half of the respondents reported that they have visited natural spa destinations for curative purposes. Regarding the visiting groups, more than half of the respondents (60%) were travelling with family as the primary party, and about 30% were visiting the spa with friends and colleagues. The social change in Taiwan has increased the opportunities for targeted marketing based on different family life-cycle stages, for example, increased economic status and leisure time combined with shorter working hours in modern life. Travelling with family members was the most commonly reported motivation. Regarding the spending at spa destinations, more than 50% of the respondents said that they spend less than NT$10,000 (US$330) on spa products each year, whereas the remaining 39% of mature and 17% of younger travellers spend NT$10,000-NT$40,000 on spa products each year.

c. Travel Motivations Factor analysis was performed to identify the underlying dimensions of the travel motivations in this study. Initially, 24 push and 19 pull motivation variables were chosen to be factor analysed. PCA orthogonal varimax rotation was performed to reduce the push items and pull items of Taiwanese mature spa travellers’ motivations into specific underlying constructs. In addition, the statistical technique was used to determine the linear combinations of the motivation variables and investigate the interrelationships between. Items that had low correlations with the overall score of the questionnaire were dropped from further analysis. The first step of PCA was to examine whether the inter-correlation among the variables met the similarity variables. The latent root criterion factors with eigenvalues greater than one were extracted. In accordance with the rules, principal components with higher variance than the standardised original variables should be extracted. An extracted factor communality loading greater than 0.50 was considered valid for including the item in a factor analysis. The reliability and validity of factors were measured by Cronbach’s alpha, which was calculated for each identified dimension to test their internal consistencies and reliability. The PCA technique produced three underlying spa destination attributes: commercial internal; commercial external; and natural and friendly service. Four underlying push motivation factors were ‘personal health and relationship building’, ‘education and learning’, ‘feeling good’, and ‘arranged treatment’. The main distinguishing motivation dimensions were ‘personal health and relationship building’ and ‘commercial external’, which appeared to have significant differences with regard to the age groups. The results of this study suggest that at least four main motivation dimensions benefiting spa tourism exist in Taiwan. In addition, it appears that mature travellers are looking for different products and services in order to meet their needs. These results imply that the marketing segmentation should be clearly identified. This information can be used to guide decisions related to the development of marketing strategies, the quality of the spa environment, or the expansion of social responsibility.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1.3.

5. Conclusions and Implications Spa tourism is beginning to change in Taiwanese society. People visit mineral spring or spa destinations so that they can relax or for curative purposes with alternative therapies. New emerging spa marketers must be conscious of the opportunities of the market segments and promote different packages and services in order to attract health travellers. One of the most important marketing strategies is the need for a clear wellness concept. The findings have health spa marketing implications in conjunction with valid information for the theoretical framework. Additionally, the findings will add to the knowledge of the practical mature travel group, will help make improvements to government policy, and will work towards methodological concerns in further research. To maintain a leading edge in competitive health tourism, spa marketers need to keep in mind the changeable motivations and trends in different spa travellers’ needs. The following recommendations are aimed at the spa tourism market: a) to distinguish spa travellers into spiritual and rehabilitation travellers; b) to manage the high level of qualified staff with further training in treatment skills; c) to establish good relationships and cooperate with policy makers; and d) to explore suitable wellness programmes to meet different groups’ needs. Note A draft version of this chapter was published as Hsieh, Mei-ting (Jessica), 2010, “Understanding mature traveller’s demand and choice in spring destination”, Proceedings of the international annual conference "TTRA 2010. Health, Wellness and Tourism – healthy tourists, healthy business?". Budapest, 1-3 September 2010 [CD-rom], TTRA, Budapest.

References Moschis, G.P., Lee, E., Mathur, A., 1997, Targeting the mature market: Opportunities and challenges, Journal of Consumer Marketing, 14, 282-293. Norman, W. C., Daniels, M. J., McGuire, F., Norman, C. A., 2001, Whither the mature market: An Empirical Examination of the travel motivations of Neo-Mature and Veteran-Mature Markets, Journal of Hospitality & Leisure Marketing, 8(3/4), 113-130. Tourism Bureau of Taiwan, 2004, Annual report of tourism industry of Taiwan, Taipei, Taiwan.

Author’s Contacts MEI TING HSIEH | jessicah62@hotmail.com TIMOTHY JEONGLYEOL LEE | timothylee728@gmail.com

PART 2

RESULT Focussed CASE STUDIES

Go to Index

Socioeconomic Impacts of Health Tourism: An Analisys of a Portuguese Programme

2.1. MARIA JOĂ&#x192;O CARNEIRO * CELESTE EUSĂ&#x2030;BIO ** ELISABETH KASTENHOLZ *** HELENA ALVELOS ****

* PhD in Tourism at the University of Aveiro (Portugal), Researcher of the Research Unit in Governance, Competitiveness and Public Policy and Assistant Professor at the Department of Economics, Management and Industrial Engineering of the University of Aveiro, Portugal. ** PhD in Tourism at the University of Aveiro (Portugal), Researcher of the Research Unit in Governance, Competitiveness and Public Policy and Assistant Professor at the Department of Economics, Management and Industrial Engineering of the University of Aveiro, Portugal. *** PhD in Tourism at the University of Aveiro (Portugal), Researcher of the Research Unit in Governance, Competitiveness and Public Policy and Associate Professor at the Department of Economics, Management and Industrial Engineering of the University of Aveiro, Portugal. ****PhD in Engineering Sciences at the Faculty of Engineering of University of Porto (Portugal), Researcher of CIDMA - Center for Research and Development in Mathematics and Applications, University of Aveiro, Portugal and Assistant Professor at the Department of Economics, Management and Industrial Engineering of the University of Aveiro, Portugal.

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.1.

Abstract This chapter aims to analyse the impacts of a programme of social tourism in the field of health tourism â&#x20AC;&#x201C; the Senior Health and Thermalism Programme (Programa SaĂşde e Termalismo SĂŠnior) promoted by the INATEL Foundation - on local development. To achieve this objective, those responsible for a group of organizations (accommodation units, hot springs, transportation companies, travel agencies, INATEL delegations, entertainment companies and local commerce), which participated in the programme from 1997 to 2007, were surveyed. The results obtained show that, globally, those responsible for the entities involved perceived positive impacts of the programme, both at the micro (within the organization itself) and at the macro level (in the municipality where the organization is located). However, impacts were perceived as more significant at the macro than at the micro level and differences were also observed between distinct types of organizations regarding the benefits perceived. The chapter closes with the presentation of the main conclusions of the study and some recommendations.

Keywords: health tourism, social tourism programmes, tourism impacts, local development.

Note: This chapter was developed based on a study carried out by researchers of the University of Aveiro, for the INATEL Foundation, concerning the socioeconomic impacts of the Senior Health and Thermalism Programme from 1997 to 2007.

2.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1. Introduction The improvement of individuals’ physical and intellectual well-being is a central aspect of modern societies (Mueller and Kaufmann, 2001). Tourism is one of the activities that can have positive effects on the well-being of the participants (Moura et al., 2009; Neal et al., 2007; Smith and Kelly, 2006). Nevertheless, there are types of tourism that due to their particularities assume greater relevance in this context, such as health tourism. This type of tourism has been growing considerably in the last decades worldwide, which can be explained not only by the greater importance that modern societies attribute to well-being and quality of life, but also by the aging population (Eusébio et al., 2010). On the other hand, social tourism, which aims to allow less-favoured people access to tourism, has also been growing. Senior citizens are one of the groups that frequently present some weaknesses in terms of health and economic constraints, making their participation in tourism difficult (Eusébio et al., 2010). For this reason, social tourism programmes that incorporate a health tourism component have been developed. Despite the relevance of social health tourism programmes for the well-being of the participants and for the development of the host communities, the number of studies on the socioeconomic impacts of these programmes is small. This study evaluates the socioeconomic impacts of a Portuguese social health tourism programme – the Senior Health and Thermalism Programme (Programa Saúde e Termalismo Sénior), organized by INATEL. The evaluation is performed through the analysis of the perceptions that a group of entities (accommodation units, hot springs, transportation companies, travel agencies, INATEL delegations, entertainment companies and local commerce) that participated in the programme between 1997 and 2007 have about its impact at the micro level - in the organization itself – and at the macro level – in the municipality where the organization is located. The present chapter is organized as follows: the next section presents a literature review about the relevance of health tourism and the third section discusses conceptually the role of thermalism in local development. In the fourth section, the empirical study about the perception of the impacts of the Senior Health and Thermalism Programme on the participant organizations and on local development is presented. This section includes the characterization of the programme and the methodology used to conduct it, as well as the presentation and discussion of the results obtained. The chapter ends with the main conclusions and some suggestions for future work.

2.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2. Health Tourism The term “health” refers to much more than just “absence of illness”, as emphasized by the World Health Organization (WHO, 1948), which refers to a state of complete well-being in the physical, mental and social dimensions. From this perspective, any tourism activity may be considered as promoting health. Mueller and Kaufmann (2001, p. 2) consider that “wellness” is a state of health that includes as central elements: “harmony of body, mind and spirit, with self-responsibility, physical fitness/beauty care, healthy nutrition/diet, relaxation (need for distressing)/meditation, mental activity/education and environmental sensitivity/social contacts”. Tourism may help to obtain all these benefits, which may result in an effective positive impact on tourists’ quality of life (Neal et al., 2007), with this effect being particularly evident in the case of health and wellness tourism (Moura et al., 2009; Smith and Kelly, 2006). Estimations of the importance of the health and wellness market suggest that the primary demand for international travel accounts for 3 million trips of one or more nights in duration, representing approximately 1.2% of the total trips made by Europeans, while about 7 million trips made by Europeans are estimated to have a complementary health and wellness component. Portugal’s market share in this market is estimated at about 1.4%, occupying the eighteenth rank amongst the main European health and wellness destinations (Turismo de Portugal, 2006). Tourist activity for health reasons, or “health tourism”, may, in fact, encompass a broad diversity of types and specific formats of tourist experiences, as highlighted by Smith and Puczkó (2009), who distinguish predominantly physical activities from those that are predominantly spiritual, as reflected in a range of pursuits that may be classified as: • holistic (spiritual, yoga); • leisure and recreation (including beauty treatments, fitness); • medical wellness (therapeutic recreation); • medical therapeutic (rehabilitation, recuperation); • medical surgical (operations). The emphasis may thus be rather on the dimension of wellness/well-being or on the medical dimension. Several studies focusing on thermal and health tourism in different countries confirm the outstanding role of natural resources in the success of a health resort or destination, not only in the treatments themselves (mineral water, thermal gas, mud baths), but also in shaping the landscapes and the environment (Ogorlec and Snoj, 1998; Ramos, 2005). On the other hand, apart from natural resources, entertainment, sports and recreational activities are increasingly sought by health and wellness tourists as important complementary offers in these destinations (Becheri, 1989; Deng, 2008; Fontanari and Kern, 2003; Kapczyńskia and Szromek, 2008; Ogorlec and Snoj, 1998; Ramos, 2005). The evolution of health tourism forms and destinations is indeed observable, from the traditional format focusing on the therapeutic, medically oriented dimension towards the creation of more modern concepts of spas that incorporate a more holistic perspective of health and wellness (Becheri, 1989; Deng, 2008; Fontanari and Kern, 2003; Kapczyńskia and Szromek, 2008; Ogorlec and Snoj, 1998; Ramos, 2005). This evolution of the product responds to a previous evolution within the market, which is increasingly educated, health conscious and concerned with quality of life in its diverse dimensions, while modern daily life is increasingly affected by unhealthy external pressures, particularly in urban areas, where the largest part of

2.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

the population in modern societies resides and works. There are apparently increasing numbers of individuals, in diverse age ranges, who seek these new (or renewed) health tourism destinations, without being seriously affected by any disease: people who intend to prevent health problems, who want to be physically “in shape” and who want to gain a new quality of life. Even if the senior market continues to be the traditionally most present group of individuals at the hot springs in many countries, like Portugal, this market is also increasingly looking for new and diverse benefits. Senior individuals come not only for therapeutic reasons, but also for prevention and to seek general well-being, in the context of an aging modern society, in which conditions of health care have improved and in which new groups of senior citizens are observable, with different types of tourism and leisure experiences and new and diverse lifestyles. This dynamic evolution of the health tourism market is also visible in Portugal, a country rich in thermal resources, particularly in the country’s centre and north, where about 53% (19) and 36% (13) of the 36 thermal destinations existing in Portugal are located (Turismo de Portugal, 2010). The majority of these thermal destinations are situated in rural, generally economically marginalized, areas.

3. Health Tourism and Local Development Tourism is one of the most important economic activities worldwide (Archer, 1995; Blake, 2009; Eusébio, 2006; Frechtling and Horváth, 1999; Liu and Var, 1983; Scheyvens and Momsen, 2008). According to several authors (e.g. Archer, 1995; Eusébio, 2006; Scheyvens and Momsen, 2008), tourism may promote the development of host communities through its capacity to attract investments and create new jobs. On the other hand, health tourism is considered in the literature as a type of tourism showing important growth tendencies, both worldwide and in Portugal. In this country, there is a significant number of hot springs, mainly concentrated in the northern and central regions, which highlights the country’s potential as a health tourism destination (ATP, 2008; Eusébio et al., 2010; Fontanari and Kern, 2003; Ramos, 2005). Hot springs play a crucial role in attracting visitors, contributing to the development of many tourism destinations all over the world, as in the case of Portugal (Eusébio et al., 2010; Fontanari and Kern, 2003; Ramos, 2005). Additionally, these are natural resources that belong to the group of endogenous resources of a tourism destination, the economic value of which is directly related to tourism development. In order to use these resources as tourism attractions, the host communities have to create several tourism facilities. This entire process has implications for the social, cultural and economic development of these tourism destinations (Lee and King, 2008). The use of hot springs by visitors and the development of new economic activities that provide visitors with other products will contribute to creating jobs, generating additional household income, diversifying the local economic structure and increasing the state revenues. As a consequence, the development of health tourism has a relevant role in the economic development of tourism destinations that offer this type of tourism attraction, contributing positively to maintaining the population in these locations, which are frequently characterized by low levels of economic development (Eusébio et al., 2010; Fontanari and Kern, 2003). The fact that a considerable number of hot springs worldwide, and particularly in the case of Portugal, are located in economically and demographically depressed regions adds to the crucial role that these natural resources assume in the development process of these regions. However, health tourism only has this role when effectively contributing to the sustainable development of these regions, as suggested by several authors (e.g. Lee and King, 2008).

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.1.

The role of health tourism in local economic development may be evaluated using several approaches. A literature review of studies on tourism’s economic impact, published in the last four decades, reveals that mathematical models quantifying the total economic impacts of tourism (e.g. Bergstrom et al., 1990; Frechtling and Horváth, 1999; Fresenmair et al., 1989; Kumar, 2004; Lichty and Steines, 1982; Mayen et al., 2010) and models assessing the hosts’ perceptions of tourism impacts (e.g. Andereck et al., 2005; Brunt and Courtney, 1999; Carneiro and Eusébio, 2010; Haley et al., 2005; Haralambopoulos and Pizam, 1996; Hilary et al., 2001; Nunkoo and Ramkissoon, 2010) have been the most frequently used approaches. A limited number of studies analyse the perceptions of tourism suppliers concerning the role of health tourism in local development (Byrd et al., 2009). Additionally, the literature about the role of health tourism in local economic development is very scarce, with only a limited number of studies analysing this topic empirically (Lee and King, 2008). However, the theoretical reflections published in this area suggest high potential benefits of this kind of tourism for local communities (Lee and King, 2008; Ramos, 2005). In Portugal, the senior market is the most important segment of hot spring clients (ATP, 2008; Eusébio et al., 2010; Ramos, 2005). However, this segment frequently has economic constraints that make participation in tourism activities difficult (Fleischer and Pizam, 2002; Neves, 2006). In order to stimulate the participation of this segment in tourism activities, several countries have been developing social health tourism programmes. In Portugal, the INATEL Foundation is promoting the Senior Health and Thermalism Programme. This programme has a strong social character by providing lower-income senior citizens with the opportunity to travel, contributing to a decrease in their isolation and an increase in their social interaction, not only with other senior participants, but also with residents at the destinations visited. On the other hand, since the programme incorporates thermal treatments, it contributes positively to the senior citizens’ well-being and to the improvement of their health conditions. Additionally, this programme has an important role in the local development of tourism destinations through the increase in tourism demand for these places. In order to satisfy this tourism demand, several other economic activities are stimulated, leading to increased revenues at the destination, with other relevant economic impacts being the increase in employment, in household income, in state revenues and revitalization of traditional activities. Besides the social and economic role of this type of social health tourism programme, there is a lack of research and empirical evidence about its benefits to host communities. In order to expand the knowledge in this field, in the next section, the results of a study that analyses the perceptions of the socioeconomic impacts of this programme by those responsible for a group of organizations (accommodation units, hot springs, transportation companies, travel agencies, INATEL delegations, entertainment companies and local commerce) that participated in this programme from 1997 to 2007 will be presented.

4. Perceptions of the Organizations that Participate in the Senior Health and Thermalism Programme About its Impacts 4.1. Characterization of the Programme The Senior Health and Thermalism Programme is a conjoint initiative of the Ministry of Health and the Ministry of Labour and Social Solidarity, financially subsidized by the PAII – the Integrated Programme for Assistance to the Elderly, and assumes a strong social character. This programme commenced in 1997 and is targeted to Portuguese citizens aged 60 years or older, who may

2.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

be accompanied by their spouses (independently of their age or thermal treatment needs) or by another Portuguese citizen, aged over 18, if assistance is needed. A medical prescription is also required. The prices vary according to the level of income of each senior citizen.

The entire development process of the programme, as well as its commercialization, implementation and evaluation, is carried out by the INATEL Foundation (National Institute for Workers’ Leisure Time Occupation), which is tutored by the Ministry of Labour and Social Solidarity (Decree-law no. 106/2008). The main social benefits that are expected to be achieved with the Senior Health and Thermalism Programme are those of satisfying the health and well-being needs of the senior market by means of the thermal treatments included in the programme and by allowing senior citizens with lower income levels access to tourism, reducing their isolation and increasing their interactions with other participants and with the local communities of the destinations visited. At an economic level, the programme aims to contribute to the development of economic activities connected with the tourism sector, namely delivering goods and services directly to the senior visitors (accommodation, thermal treatments, food services, transportation, entertainment and commerce), as well as stimulating other activities, as a result of the multiplier effect of the expenditures undertaken by tourists. These economic effects – direct, indirect and induced – contribute to local, regional and national development. As the temporal scope of this programme coincides largely with the off-season of tourism supply, it may additionally contribute to the reduction of seasonality at several destinations. The trips included in the programme have a duration of 15 days (14 nights) and include half pension accommodation, transportation and entertainment activities. They also involve some recreational activities that aim at learning and cultural enrichment of the participants. The destinations are located exclusively in Portugal, namely in the promotion areas of Porto and North Portugal, Beiras and Lisbon and the Tejo Valley (INATEL, 1997-2007). The number of annual participants in the programme between 2000 and 2007 was above 4,000, being about 4,800 in 2007. In the same period, the number of entities/companies that participated in the programme increased significantly, mainly regarding points of sales (which increased from 234 in 2000 to 482 in 2007) and hot springs (which increased from 8 in 2000 to 16 in 2007). It must also be noted that, in 2007, the number of accommodation units associated with the programme was 18, the number of entertainment companies was 85 and the number of road transportation companies was 18 (Eusébio et al., 2010).

4.2. Methodology The perceptions of the managers of the participant organizations about the impacts of the Senior Health and Thermalism Programme between 1997 and 2007 were identified and measured through the application of a questionnaire to the entities included in INATEL’s database. The surveyed entities were those that played a fundamental role in the programme, namely in terms of promotion and commercialization – INATEL’s offices and travel agencies, goods and services supply – hot springs, accommodation units, entertainment companies and road transportation companies – as well as local commerce establishments that benefit from the programme. The evaluation of the impacts at the micro level (on the organizations themselves) was performed based on two groups of questions. The first one was about changes in the organizations as a consequence of their participation in the programme, for which a list of 12 possible changes was presented (e.g. changes in equipment to improve services – mobility/accessibility or recruitment of additional staff). If changes had been intro-

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.1.

duced, the respondents were requested to evaluate their impact on the organization using a scale from 1 (very negative) to 5 (very positive). The second group of questions referred to the perception of the global impact of the programme on 5 crucial organizational aspects, namely sales/occupancy, service quality, employment generated, seasonality and profitability, again measured on a scale from 1 (very negative) to 5 (very positive). The evaluation of the impacts at the macro level (on the municipalities in which the companies that participated in the programme are located) was also performed based on two groups of questions. In the first group, managers were asked about their perceptions of the programmeâ&#x20AC;&#x2122;s impacts on eight aspects related to the municipality where the respective organizations were located (e.g. diversification of local economic activities). The scale used was the one just described (1 to 5). The second group consisted of a single question, which asked managers about the percentage of purchases that were made by the respective companies in the municipality where they are located. The entities surveyed were all the hot springs (18), all the accommodation units (27) and all the road transportation companies (22) that participated in the programme. In the cases of points of sales (mostly travel agencies) and entertainment companies, due to their large number, stratified samples were selected in order to ensure the representativeness of these units. The criterion used for the stratification was the location of the organizations, and 6% of the last two types of companies were surveyed: specifically, 36 points of sales and 21 entertainment companies. As the exact number of the local commerce establishments visited by these social tourists was not known, 17 of those shops located in areas surrounding the accommodation units were selected by convenience sampling. Most of the questionnaires were administered directly or by telephone. In some cases, when this was not possible, e-mail or fax approaches were used.

4.3. Analysis and Discussion of the Results 4.3.1.Impacts of the Programme on the Participating Companies

With regard to the socioeconomic impacts of the Senior Health and Thermalism Programme, the analysis included the changes introduced in the organizations that participated in the Senior Health and Thermalism Programme as a result of their participation in the programme. The changes introduced by a large number of companies were changes to menus (introduced by 56% of the companies), changes to the equipment for treatment (introduced by 26.7% of the companies given the nature of the programme), repairs of vehicles (22.2%) and the recruitment of additional staff (13%) (Figure 1). Between 8% and 10% of the companies undertook interior or exterior repairs of infrastructures, made changes to equipment to improve services â&#x20AC;&#x201C; mobility/ accessibility, comfort and opportunities for recreation/leisure â&#x20AC;&#x201C; and provided training to their employees. Few companies carried out changes in order to improve safety or health or other types of changes.

2.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Figure 1 | Changes Introduced by the Companies that Participated in the Programme. Change of menus

56.0

Equipment for treatments

26.7

Repairs of vehicles

22.2

Recruitment of additional staff

13.0

Equipment to increase mobility and accessibility

10.3

Interior or exterior repair of infrastructures

10.3

Specific education/training of employees

8.7

Equipment to increase comfort

8.6

Entertainment and leisure equipment and activities

8.0

Internal readjustment of employees

4.3

Change of safety conditions

3.4

Change of hygiene conditions

3.4

Other changes

0.9 0

% of companies that introduced changes

Source: Developed by the authors based on the survey applied to the companies that participated in the programme.

It is interesting to note that all the changes are perceived as having a positive impact, except for some changes introduced by a small number of companies – changes to safety and hygiene conditions (which, on average, those responsible for companies consider having neither a positive nor a negative impact) and the readjustment of employees (which those responsible for companies consider having a very negative impact) (Figure 2). The changes related to equipment for treatments, adopted by a considerable number of companies (26.7%), are, together with other changes (changes not specifically identified in the questionnaire), the changes that in the opinion of the respondents generated a more positive impact on the companies (5 on a scale from 1 “very negative” to 5 “very positive”). However, several changes introduced by a group of 8% to 10% of the companies – including specific training for employees and changes to equipment to increase mobility/accessibility and comfort - as well as the recruitment of additional staff – also had a considerably positive impact (between 3.9 and 4.4 on the above-mentioned scale). These data demonstrate the importance of investing in staff and improving accessibility and comfort, changes that allow the improvement of quality and the setting into value of the tourism supply of the destinations integrated into the programme. Figure 2 | The Impact of Changes Introduced by Companies on the Quality of the Service Provided. Equipment for treatments

5.0

Other changes

5.0

Equipment to increase mobility and accessibility

4.4

Specific education/training of employees

4.3

Equipment to increase comfort

4.0

Recruitment of additional staff

3.9

Entertainment and leisure equipment and activities

3.5

Repairs of vehicles

3.5

Interior or exterior repair of infrastructures

3.4

Change of menus

3.4

Change of safety conditions

3.0

Change of hygiene conditions

3.0

Internal readjustment of employees

1.0 1

Global average of companies

Legend: 1 “very negative” to 5 “very positive”. Source: Developed by the authors based on the survey applied to the companies that participated in the programme.

2.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Regarding the programme’s global impact on the companies that participated in it, and taking into account the global average of all the companies surveyed, the respondents consider that the programme has a higher impact on sales/occupancy (3.9), on decreasing seasonality (3.8) and on profitability (3.7) than on service quality (3.4) and on the employment generated (3.3) (Table 1). However, comparing the opinions of those responsible for the different types of companies, one may notice that those responsible for local commerce and for points of sale are those with a less positive opinion about the various impacts. The major differences of opinion among those responsible for the other companies regard the programme’s impact on the quality of the service and on the employment generated, with those responsible for hot springs revealing a more favourable opinion in relation to the impact on service and those responsible for the accommodation units having a more favourable opinion regarding employment. Hence, as far as employment is concerned, 44% of the accommodation units, 13.3% of the hot springs and 11.1% of the road transportation companies recruited additional staff as a consequence of their participation in the programme. This highlights the positive effect that the programme has in increasing the number of jobs. Regarding profitability, those responsible for entertainment companies reported that the programme represented a greater percentage of their sales (45% of sales), followed by those responsible for the accommodation units (21.1%) and hot springs (16.3%). Table 1 | The Programme’s Global Impact on the Participating Companies Programme's overall impact on companies that participated in the programme

Accomodation units

Hot springs

Entertainment companies

Road transportation companies

Local commerce

Points of sale

Companies’ total

Average

Impact on sales/ occupancy

4.2

4.0

3.9

3.5

3.6

126

3.9

Impact on service quality

3.5

3.9

3.3

3.7

3.4

3.2

126

3.4

Impact on employment generated

3.8

3.5

3.0

3.6

3.1

3.0

126

3.3

Impact on seasonality

4.1

4.0

4.2

3.8

3.6

3.4

125

3.8

Impact on profitability

3.9

4.0

3.8

3.6

3.2

126

3.7

Legend: 1 “very negative” to 5 ”very positive”. Source: Developed by the authors based on the survey applied to the companies that participated in the programme.

2.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

4.3.2. Impacts of the Programme on Municipalities Where Participating Companies are Located

Those responsible for companies that participated in the programme were also asked about the impact of the programme on local development. The results suggest that respondents tend to have a more positive view of the impacts that the programme has on the municipality where their companies are located than on the impacts that the programme has on the company for which they are responsible (Tables 1 and 2). Considering the opinion of those responsible for the companies, the highest impacts that the programme seems to have at the municipality level are the contributions to the setting into value of regional products, folklore and traditions and to the increase in the quality of tourism supply (all classified as having an impact of 4.2) (Table 2). However, the programme also seems to have a major impact on raising the quality of local entertainment, on the diversification of local economic activities and on the stimulation of the local economy (with impacts from 3.9 to 4.0). Table 2 | The Impact of the Programme in the Municipalities Where the Participating Companies are Located Impact of the programme in the municipalities where the organizations are located

Accomodation Units

Average

Quality of entertainment

4.0

4.2

4.1

3.5

4.0

Social life in local communities

3.8

4.1

4.0

3.6

3.9

Setting into value of regional products

4.1

4.5

4.2

Setting into value of folklore and traditions

4.1

4.4

4.1

4.2

Employment generated

3.7

3.9

3.4

3.7

Quality of the tourism supply

4.3

4.5

3.4

4.2

Diversification of local econ. activities

3.8

4.1

4.0

3.5

3.9

Stimulation of local economy

3.9

4.1

4.0

3.6

3.9

Hot springs

Entertainment companies

Local commerce

Companies’ total

Legend: 1 “very negative” to 5 ”very positive”. Source: Developed by the authors based on the survey applied to the companies that participated in the programme.

The managers of local commerce businesses are, once more, those who have a more negative opinion concerning the impacts of the programme in the municipality. This possibly happens because the other entities have more direct involvement in the programme, which involves a contract, while the local commerce only benefits from the programme in an indirect way, through the purchases made by a usually small number of tourists participating in the programme, who might not always be easy to distinguish from other spa tourists as programme participants. Those responsible for entertainment companies are, together with those responsible for the hot springs, those who have a more positive perspective regarding the impacts of the programme in the municipality where the companies are located. Those responsible for hot springs even have a more positive view than those responsible for entertainment companies regarding the setting into value of regional products and traditions. This is probably related to the type of activities that entertainment companies develop. The percentage of purchases undertaken by companies participating in the programme in the municipality where they are located shows that these companies make a great contribution to the stimulation of the local economy of the municipalities where they are located. This percentage is particularly high in the case of entertainment companies (98.6%), hot springs (84.5%) and accommodation units (83.9%) (Figure 3). These data clearly suggest that the programme contributes to the stimulation of the local economy, not only through the direct effects it generates, but also due to the economic linkages produced, giving rise to important indirect economic effects.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.1.

Figure 3 | Percentage of Purchases Made by Companies Participating in the Programme in the Municipality Where they are Located

Entertainment companies

98.6

Hot springs

84.5

Accommodation units

83.9

Road transportation companies

50.4 0

100

Average % of purchases made in the municipality where the organization is located

Source: Developed by the authors based on the survey applied to the companies that participated in the programme.

5.Â Conclusions and Recommendations Health tourism has been growing and is nowadays considered a relevant contributor to local economic development. However, the literature in this field is very scarce, particularly concerning studies that empirically reveal this role of health tourism in local development from diverse stakeholdersâ&#x20AC;&#x2122; points of view, stressing the relevance of the study presented in this chapter. In this study, the perceptions of diverse entities participating in the organization and implementation of a Portuguese social health tourism programme regarding its socioeconomic impacts were analysed. The results of the study reveal that the participating entities in the programme consider that this social initiative has positive impacts, both in the organization for which they are responsible and in local economic development. In addition, these results highlight the important role of health tourism, and in this particular case of a Portuguese social health tourism programme, in the revitalization of the local economy. Therefore, when health tourism is developed in a destination, a set of resources, often underutilized ones, begins to play an important role in the development strategy of this area. The increase in sales and occupation rates, the increase in profitability and the reduction in seasonality were the impacts of the social health tourism programme analysed in this chapter that were most perceived by the entities involved in its organization and implementation. These results clearly show that the promotion of these initiatives is a relevant strategy in order to reduce the seasonality of tourism in health tourism destinations and to increase the profitability of the economic activities involved in the supply of this tourism product. Regarding the socioeconomic impacts of the Portuguese social health tourism programme, some differences in the views of the participating entities were observed. These differences may be related to their level of involvement in the organization and implementation of the programme. At this level, it was observed that the entities participating with greater involvement in this social programme, such as the hot spring and entertainment companies, perceived more positive impacts of the programme.

2.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

The results presented also suggest that the respondents perceive more positive impacts of the social programme at the macro level (in the community where the organization is located) than at the micro level (the organization for which they are responsible). This conclusion again stresses the apparent relevance of social health tourism programmes in stimulating the economic and social development of local communities, particularly the most economically disadvantaged. In addition, the results of this study reveal that this programme makes significant contributions in terms of enhancing the endogenous resources of the tourism destinations, improving the quality of the tourism supply, revitalizing traditions and setting into value typical regional products. Accordingly, these results corroborate the hypothesis that social health tourism programmes, apart from their important role in the well-being of the social groups involved and directly benefiting from this offer, individuals who otherwise might not have the possibility of engaging in tourism, are an important development tool for the tourism destinations in which they are implemented. Consequently, there are strong arguments justifying the public funding of these kinds of programmes. In order to increase the knowledge in this field it would be important to conduct studies to assess the socioeconomic impact perceptions of all the stakeholders involved in this kind of social programme, particularly also considering the tourists who participate in the programme and the residents of the destinations. In addition, the analysis of the socioeconomic impact perceptions of other social health tourism programmes could permit comparative studies. Finally, it would be interesting to undertake studies to quantify, with mathematical models, the total economic impacts of this kind of social programme on local communities. Acknowledgements

This work was supported in part by FEDER funds through COMPETE (Operational Programme Factors of Competitiveness) and by Portuguese funds through the Center for Research and Development in Mathematics and Applications and the Portuguese Foundation for Science and Technology (FCT), within project PEst-C/ MAT/UI4106/2011 with COMPETE number FCOMP-01-0124-FEDER- 022690.

References Andereck, K. L., Valentine, K. M., Knopf, R. C., Vogt, C. A., 2005, Residents’ perceptions of community tourism impacts, Annals of Tourism Research, Vol. 32(4),1056-1076. Archer, B., 1995, The impact of international tourism on the economy of Bermuda, 1994, Journal of Travel Research, Vol. 34(2), 27-30. ATP, 2008, Estatísticas, Associação das Termas de Portugal, Lisboa. Becheri, E., 1989, From thermalism to health tourism, Tourism Review, Vol. 44(4), 15-19. Bergstrom, J. C., Cordell, H. K., Ashley, G. A., Watson, A. E., 1990, Economic impacts of recreational spending on rural areas: A case study, Economic Development Quarterly, Vol. 4(1), 29-39. Blake, A., 2009, The dynamics of tourism’s economic impact, Tourism Economics, Vol. 15(3), 615-628. Brunt, P., Courtney, P., 1999, Host perceptions of socio-cultural impacts, Annals of Tourism Research, Vol. 26(3), 493-515. Byrd, E. T., Bosley, H. E., Dronberger, M. G., 2009, Comparisons of stakeholder perceptions of tourism impacts in rural eastern North Carolina, Tourism Management, Vol. 30, 693-703. Carneiro, M. J., Eusébio, C., 2010. Hosts’ perceptions of tourism impacts in an urban area – A cluster analysis, in Metin Kozak (ed.) Proceedings Book of the 5th World Conference for Graduate Research in Tourism, Hospitality and leisure, Ankara: Detay Yayincilik, 362-369. Decree-law 106/2008, Diário da República- 1.ª série, N.º 121, de 25.06.2008, p. 3826. Deng. W., 2008, Using a revised importance-performance analysis approach: The case of Taiwanese hot springs tourism, Tourism Management, Vol. 28(5), 1274-1284. Eusébio, C., 2006, Avaliação dos impactes económicos do turismo a nível regional: o caso da Região Centro de Portugal, Dissertação de Doutoramento, Universidade de Aveiro, Aveiro, Portugal.

2.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Eusébio, C., Carneiro, M. J., Kastenholz, E., Alvelos, H., 2010, Estudo de impacto sócio-económico dos Programas Sáude e Termalismo Sénior de 1997 a 2007. Relatório do Estudo realizado pela Universidade de Aveiro para o INATEL. Fleischer, A., Pizam, A., 2002, Tourism constraints among Israeli seniors, Annals of Tourism Research, Vol. 29(1), 106-123. Fontanari, M., Kern, A., 2003, The “Comparative Analysis of Spas” – An instrument for the re-positioning of spas in the context of competition in spa and health tourism, Tourism Review, Vol. 58(3), 20-28. Frechtling, D. C., Horváth, E., 1999, Estimating the multiplier effects of tourism expenditures on a local economy through a regional input-output model, Journal of Travel Research, Vol. 37, 324-332. Fresenmair, D. R., Jones, L., Um S., Ozuna, T. Jr., 1989, Assessing the economic impact of outdoor recreation travel to the Texas Gulf Coast, Journal of Travel Research, Vol. 28(1), 18-23. Haley, A. J., Snaith, T., Miller, G., 2005, The social impacts of tourism: A case study of Bath UK, Annals of Tourism Research, Vol. 32(3), 647-668. Haralambopoulos, N., Pizam, A., 1996, Perceived impacts of tourism: The case of Samos, Annals of Tourism Research, Vol. 23(3), 503-526. Hilary, M., Nancarrow, B., Griffin, G., Syme, G., 2001, Tourist perception of environmental impact, Annals of Tourism Research, Vol. 28(4), 853-867. INATEL (1997-2007). Brochuras do Programa Saúde e Termalismo Sénior, INATEL, Lisboa. Kapczyńskia, A., Szromek, A. R., 2008, Hypotheses concerning the development of Polish spas in the years 1949–2006, Tourism Management, Vol. 29(5), 1035-1037. Kumar, N. P., 2004, Economic impact of tourism on Fiji’s economy: Empirical evidence from the computable general equilibrium model, Tourism Economics, Vol. 10(4), 419-433. Lee, C.-F., King, B. E., 2008, Using the Delphi method to assess the potential of Taiwan’s hot springs tourism sector, International Journal of Tourism Research, Vol. 10, 341-352, DOI: 10.1002/jtr.661. Lichty, R. W., Steines, D. N., 1982, Measuring the impact of tourism on a small community, Growth and Change, 36-39. Liu, J., Var, T., 1983, The economic impact of tourism in metropolitan Victoria B.C., Journal of Travel Research, Vol. 22(2), 8-15. Mayen, M., Muller, M., Woltering, M., Arnegger, J., Job, H., 2010, The economic impact of tourism in six German national parks, Landscape and Urban Planning, Vol. 92(2), 73-82. Moura, A., Kastenholz, E., Pereira, A., 2009, Health and wellness tourism: Understanding the foundations of an increasing specialty market, Proceedings of the International Conference ATE 2009, Advances in Tourism Economics, Lusíada University, Lisbon, 23-24 April. Mueller, H., Kaufmann, E. L., 2001, Wellness tourism: Market analysis of a special health tourism segment and implications for the hotel industry, Journal of Vacation Marketing, Vol. VII(1), 5-17. Neal, J. D., Uysal, M., Sirgy, M. J., 2007, The effect of tourism service on travellers’ quality of life, Journal of Travel Research, Vol. 46(2), 154-163. Neves, J. M. O., 2006, Estudo das Motivações Turísticas e do Comportamento de Viagem dos seniores portugueses no mercado interno. Uma nova abordagem exploratória aplicada aos viajantes seniores das Universidades Portuguesas na Terceira Idade e do INATEL através de uma perspectiva funcionalista, Dissertação de Doutoramento não publicada, Universidade Lusíada de Lisboa, Lisboa, Portugal. Nunkoo, R., Ramkissoon, H., 2010, Small island urban tourism: A residents’ perspective, Current Issues in Tourism, Vol. 13(1), 37-40. Ogorlec, A., Snoj, B., 1998, Guests’ satisfaction with tourism services: A case of health resorts in Slovenia, Tourism Review, Vol. 53(2), 38-47. Ramos, A., 2005, O Termalismo em Portugal: dos factores de obstrução à revitalização pela dimensão turística, Tese de Doutoramento, Departamento de Economia, Gestão e Engenharia Industrial, Universidade de Aveiro. Scheyvens, R., Momsen, J. H., 2008, Tourism and poverty reduction: Issues for small island states, Tourism Geographies, Vol. 10(1), 22-41. Smith, M., Kelly, C., 2006, Wellness tourism, Tourism Recreation Research, Vol. 31(1), 1-4. Smith, M. K., Puczkó, L., 2009, Health and Wellness Tourism, Butterworth-Heineman, Oxford. Turismo de Portugal, 2006, PENT. 10 Produtos Estratégicos para o Desenvolvimento do Turismo em Portugal: Saúde e Bem-Estar, Turismo de Portugal, Lisboa. Turismo de Portugal, 2010, Termas em Portugal – Oferta e Procura em 2010 (http://www.turismodeportugal.pt/Portugu%C3%AAs/ProTurismo/estat%C3%ADsticas/an%C3%A1lisesestat%C3%ADsticas/termasemportugal/Anexos/Termas%20em%20Portugal%202010.pdf) (accessed in August 2011). World Health Organization (WHO), 1948, Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946 (http://www.who.int/about/definition/en/print.html) (accessed in May 2009).

Author’s Contacts MARIA JOÃO CARNEIRO | mjcarneiro@ua.pt CELESTE EUSÉBIO | celeste.eusebio@ua.pt ELISABETH KASTENHOLZ | elisabethk@ua.pt HELENA ALVELOS | helena.alvelos@ua.pt

Critical Analisys of the Australian Spa Hotel Industry

2.2. TIMOTHY JEONGLYEOL LEE **

** PhD, Ritsumeikan Asia Pacific University (Tourism and Hospitality Management). Dr Timothy Lee followed an MBA programme at the Long Island University in New York after gaining a Bachelor degree in Forest Environmental Science from the Seoul National University, Korea. Having worked in a variety of tourism and hospitality industry positions in Manhattan, New York, for 7 years, Dr Lee travelled to the United Kingdom to study for a Master degree in International Hotel Management and then a PhD in Tourism and Hospitality Development at the University of Surrey. Soon after he completed his doctoral research he joined the School of Tourism at the University of Queensland, Australia, in 2005. Since April 2012 he has held a tenured full professorship at the Ritsumeikan Asia Pacific University (Tourism and Hospitality Management). He has published more than 90 academic articles in refereed journals and conferences worldwide. His research interests include cultural heritage tourism, medical/health tourism, ethnic identity issues in the tourism industry, and tourism development that incorporates Asian values. He is a research note editor for the Journal of Hospitality Marketing and Management and an editorial board member for Tourism Analysis.

Go to Index

2.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Abstract As the world becomes more focussed on well-being and health issues, spas have become a mature notion for people. Australia, with a well-entrenched heritage as a spa and health tourism destination, complements the benefits of a spa and the wellness experience. In reverse, the development of ideal health tourism may strengthen the image of Australia as a stylish, sophisticated, and romantic tourism destination. The purpose of this study is to outline the current position of the Australian spa hotel industry by comparison with the situation in other countries in terms of the development background and environment, differentiation strategies, current challenges, and future trends. Considering the differentiation in terms of location, marketing segment, and development environment compared with the professions overseas, Australian spa hoteliers have begun to realise the significance of shifting the focus to leisure customers. Spa tourism is not only a complementary promotion for employees used by corporate managers; for family customers it is also a fashionable way to escape from their daily routines. The future trend is inclined to place greater emphasis on the marketing resources for domestic customers, requiring the coordination of several regional tourism bodies to build a persuasive and compelling wellness tourism image. It is believed that the current governance and planning of the spa tourism industry is far from satisfactory and that a new industrial body is required to be responsible for providing the best practice business models and introducing a standardised accreditation system. The association must establish a recognised self-regulating system, standardise self-management actions, promote equal competition between hotels, raise the integrated staff training levels, and defend the integrated benefits. In conclusion, the key message to improve the Australian spa hotel industry is to strengthen cooperation through entirety planning and standardisation.

Keywords: Spa industry, marketing strategies, Australia.

2.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1. Introduction

During the seventeenth and eighteenth centuries and before the modern mass tourism period, the European aristocracy began to realise that ‘taking the water’ was a healthy recreation (Hall, 1992). The growth of the Australian spa industry has been relatively slow, because of the limited natural spa resources and a short spa history. Nowadays, as one of the major elements of wellness and health tourism, spa tourism is a niche or special-interest market and can contribute much to the local economy (Bennett, King, and Milner, 2004). Australia has been recognised as an emerging and potential spa tourism market and destination. However, few studies offer a comprehensive analysis in terms of the differences between the global and the Australian spa industry. This article makes a comparison between the European and the Australian spa industry from the development environment and strategy perspectives, and identifies that the Australian spa industry is affected by the business, geographic, and cultural environments and has a unique industry portfolio involving both opportunities and challenges. However, given the limited previous studies on the Australian spa industry, this article uses some wellness tourism-related articles as references. This limitation may cause overestimation, bias, and errors. This paper is divided into two parts. In the first part, the tourism characteristics of the Australian spa industry are illustrated in contrast to the spa industry in European countries. The second part analyses the advantages and disadvantages, opportunities, and challenges, then offers recommendations.

2. Current Situation of the Australian Spa Industry 2.1. Target Customers Although wellness tourism has been described as a lucrative emerging market, a fuzzy boundary still exists in terms of comparable market data collected by different countries, because there is still no clear definition of the term ‘spa’. The definitions may vary dramatically, but most scholars categorise this type of tourism as a special interest market (Burkett, 2007). These markets, with their great potentials, can attract certain types of target customers and contribute to hotels’ total revenue. The members of these particular market segments have luxury money on hand and lead professional lives filled with stress at a consistent level, which emphasises the significance of catering for corporate customers. For instance, the corporate market accounts for 90% of the customer base of the Pennyhill Park Spa Hotel in the UK (Webster, 2004). For some country resorts, such as Pennyhill Park, spas have been attracting the interest of corporate group customers and encouraged the development of the hotels into wellness destination properties. However, considering the cloudy economic circumstances, hotels have to avoid putting all their eggs into the vulnerable corporate basket, and thus maximise their revenue potential by planning to enlarge their leisure customer base.

2.2.Customer Source Another major difference between the Australian and the European spa hotel industry is the share of domestic spa visitors. According to Tourism Victoria (2004), only 0.2% of all domestic visitors within Australia visited a health spa, compared with 1.2% of international visitors, in 2004. This micro market - spa visitation in Australia - is growing at a rapid rate, with an annual average growth rate of 13.8% over the period 2001–2004,

2.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

outperforming the rate of the total domestic visitation (1.6%). The guidelines are to increase the share of domestic visitors, particularly interstate customers. Health tourists in Australia are now predominantly domestic tourists. The average proportion of clients from overseas was as minimal as 6% (Voigt et al., 2010). What is also worth mentioning is that while overnight intrastate visitors account for 30% of the total sample, overnight visitors from other states only make up 19% of the total number. Competition is fierce for domestic customers among several states. For example, to top other competitors and attract visitors from neighbouring states, Victoria developed specific marketing and communication strategies with key messages for its unique product offerings, including mineral springs and geothermal waters (Tourism Victoria, 2004). The assistance of media familiarisation, cross-promotion with other tourism products, such as culinary, nature-based, and cultural heritage tourism, will also benefit the business, because packaged products may drive the whole industry and meanwhile yield higher profits.

2.3. Location Superiority Another advantage that Australian spa hoteliers may use is their unique location superiority. A study commissioned by the International Spa Association finds that Australia is the only market to rank its location as one of its most important quality attributes (Research International, 2009). With regard to the significance of the environmental surroundings, wellness tourism facilities with interior decoration have been reconciled as a decisive factor that contributes to visitorsâ&#x20AC;&#x2122; impression of health and well-being. Traditional ideal locations for spa indulgence are often facilitated by natural geothermal and mineral springs. Nevertheless, even those spa providers lacking this inborn advantage can increase their aesthetically pleasing and environmental friendly ambience, which is a major pull motivation for customers seeking escape and relaxation (Smith and Kelly, 2006). This also offers a second chance for hotels in urban areas attempting to offer spa services as a sales point by renovating the interior decoration of the spa centre.

2.4. Branding and marketing Because there is less potential for Australia to be branded as a health tourism destination from the perspective of the international market, the spa hoteliers in Australia should adopt differentiation marketing strategies with worldwide popular spa destinations such as the Alpine resorts and shift their focus to increasing the interest in the wellness of domestic visitors by establishing a wellness image and positioning. In terms of destination branding, first, local suppliers may use differentiated tourism products by marketing complementary activities associated with fitness, recreation, and relaxation (Voigt et al., 2010), and then conceptualise the destination as a synthesis of a broader service offering. This is also another embodiment of the packaged product mix and may help to increase the length of stay and expenditure of spa and wellness visitors. Next, in addition to designing a variety of activities, overall planning is required by the local tourism organisations to shape the business on a larger scale with an impressive brand image (McNeil and Ragins, 2005). Within Australia, Daylesford and Hepburn Springs have evolved as destinations with a core image of the basis of health and wellness. The regions successfully market and brand themselves with their unique natural springs through the efforts of various stakeholders, including several hotel brands and regional planners from the State Government. In contrast, Byron Bay takes a different route to attract visitors seeking wellness as a by-product of their tourism experience (Voigt et al., 2010). Thus, the key factors for building a spa destination positioning may require the co-marketing of different stakeholders and the offering of diverse wellness activities to enrich visitor experiences.

2.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.5. Cooperation and Accreditation

In terms of co-branding and co-marketing, it is also suggested that Australia benefits from regional partnerships, such as with New Zealand and Fiji. Because several successful precedents exist in regard to cooperation between the Alpine countries and the Mediterranean countries in marketing their wellness tourism products, Australia and its neighbouring countries can draw lessons from those tourism groups and seek common grounds to motivate tourists to visit. Therefore, a certain opportunity is implicit in this expectant alliance with other Oceanian countries in branding the region as a pure spa and wellness destination. However, all these ideas are based on the support and governance of the national tourism bodies. In fact, the wellness tourism industry representation, the Australian Spa Association (ASPA), is losing its authority amongst the stakeholders because of its limited resources and power over reforms (Voigt et al., 2010). It is also believed that the current accreditation lacks scientific and normative standards and a new comprehensive body is needed to form a standardised accreditation system similar to the five-star hotel rating system. Convincing accreditation may benefit the operators with sufficient resources and provide reliable assurance for customers.

2.6. Location and Culture Australia is surrounded by the Pacific and Indian Oceans and is close to the Asian continent, Pacific Island countries, and the North American and South American continents. Accordingly, Australia is a bridge between different continents and islands. Moreover, Australia is the hub of different Eastern and Western cultures, such as the Chinese, Japanese, American, and English cultures. These cultures bring colourful and exotic resources to Australian spa tourism. Given the central and convenient geographic location, numerous international visitors come to Australia, providing significant potential consumers for the spa industry. Owing to its phenomenal multiculturalism, many spa therapies from other cultures have been introduced into the Australian spa industry, such as Swedish, Thai, Lomi-Lomi, hot stone, and Shiatsu massages. In addition, a few Australian spa service providers have taken advantage of indigenous or Aboriginal philosophies and treatments, for instance Li’Tya’s distribution of spa skincare and Daintree Eco Lodge and Spa (Voigt et al., 2010). Compared with the traditional Western spa or massage treatment in European countries, the Australian spa industry offers more attractive and multicultural spa treatments. Additionally, as one of the world’s most famous and popular tourism destinations, Australia is favoured by many international visitors for its lifestyle and natural environment. The Australian relaxed and friendly lifestyle, warm climate, and diverse and beautiful natural environment are already perceived as attractive, fitting in very well with the spa services (Sebastian, 2002).

2.7. Spa History, Governance, and Policy ‘Australia’s spa sector is varied and distinct, particularly when it is compared with the more traditional spa health resorts operating in many European countries’ (Bennett et al., 2004, p. 124). One of the reasons for the differences is the short history of Australia, where there has been no significant spa flavour in the previous decades. Another reason is that the hot springs and mineral water are less well known and ready for tourism’s demands. Consequently, the lack of a strong tradition of spas in Australia is the cause of the differences between the Australian and the European spa industry (Bennett et al., 2004). Government policies and related associations play a significant role in developing the spa industry. Worldwide, many countries’ authorities, in their tourism strategies, treat wellness tourism as an important accelerator and make great efforts to promote their spa tourism. However, Tourism Australia seems to display no great interest in targeting the spa tourism niches (Australian Tourism Export Council, 2008). In addition, there are many spa industry associations in European countries, such as the German Wellness Association and the

2.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

European Spa Association (Voigt et al., 2010). They offer guidance, the latest information, and cooperation opportunities to their members. In contrast, the Australasian Spa Association (ASpa) is criticised for its lack of lobbying and benefits for members, which could be one explanation for the reducing member numbers. Moreover, spa treatment is a claimable expense for insurance companies in many European countries, but there is no recognition of the phenomenon by the relevant health insurance funds in Australia (Goodrich and Goodrich, 1987; Sebastian, 2002).

2.8. Business Environment Asian-Pacific countries are relatively new members of the global spa business (Henderson, 2003). The spa resort numbers in Australia increased by 129% in 2008 (Intelligent Spas, 2008). The Asia-Pacific region ranks third in terms of revenues, but second in terms of spa facilities. That means the Australian spa industry is a potential major spa destination with a bright future. The global financial crisis has caused a significant loss for the global tourism industry, and spa tourism in some European countries has experienced a decline. However, for the Australian spa industry, the financial crisis is more of an opportunity. Because spa experiences enable people to refresh and escape from the stress and problems caused by the crisis, and the Australian economy recovered from the crisis very quickly, the Australian spa industry experienced fast development, compared with other developed countries.

3. Differentiation Strategies Compared with the European countries, the special development environments of the Australian spa industry led to different strategies for operation, management, and promotions.

3.1. Location Owing to the lack of natural spa resources, such as spring water and mineral water, Australian spa resorts are mainly located in New South Wales and Queensland, and around the capitals Sydney and Brisbane (Bennett et al., 2004). These two places are famous tourism destinations that have convenient facilities and attract a substantial number of visitors. Therefore, the spa resorts in these two areas can attract more consumers and make more profits. From another point of view, Australian spa resorts pay more attention to their natural environment and prefer to be located in a quiet and beautiful place. According to the International Spa Association, among 15 countries studied in a report, Australia was the only country where location was ranked as one of the most important factors, rather than a stress-free environment or qualified facilities (Research International, 2009). However, compared with the European countries, many Australian spa resorts, to be surrounded by natural attractions, are located in country areas that are remote and have no public transportation (Bennett et al., 2004).

3.2. Services and Products To provide qualified services and products, it is essential for Australian spa resorts to understand the motivations of spa consumers. The top motivation is escape and relaxation, and the second is spiritual retreat, followed by physical health and appearance and to re-establish self-esteem (Voigt, 2009). According to these

2.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

visitors’ demands, Australian spa resorts should make some changes. Stress-free environments and comfortable facilities are quite significant for Australian spa resorts. The Australian spa industry emphasises health promotion and prevention, rather than medical care or rehabilitation (Puczkó and Bachvarov, 2006; Smith and Puczkó, 2008). Moreover, given the sports flavour of the Australian culture, Australian spa resorts should provide movement therapies, such as yoga and gym classes (Voigt et al., 2010). Although Australian spa resorts pay attention to their surrounding environment and physical activities, very few spa resorts mention outdoor activities. Natural walks are the only activity ever mentioned (Bennett et al., 2004). The absence of customised services and products is a shortage in the Australian spa industry. Compared with the European highly customised spa services, only half of the Australian spa providers offer individually tailored programmes. They provide only vegetarian and traditional Western-style food, and only 45% of the resorts provide individual health assessments or more specific medical checks (Bennett et al., 2004). Another block in the development of the Australian spa industry is that many spa resorts have minimum stays, usually of 5 to 12 days, which may make it difficult to arrange free time. The retail of the spa resorts is an important channel to increase revenue and cultivate brand loyalty. Almost 30% of spa service providers offer their homemade products using local ingredients, enabling consumers to be closer to the particular geographical space and atmosphere (Starr, 2006).

3.3. Communication and Promotion The first step for Australian spa resorts to promote themselves is to recognise their target markets. In contrast to the European countries with a strong spa tradition, spas attract different consumers in Australia. Australian spa tourists appear to be from a higher socio-economic status and younger than the European spa tourists. Additionally, they tend to take shorter but more frequent spa holidays (Roy Morgan Research, 2009). In correspondence with consumer preferences and behaviour, Australian spa resorts should pay attention to their advertisements and promotion on the Internet, because 41% of domestic wellness tourists use the Internet to access information. Except for the Internet, lifestyle magazines, newspapers, and free print publications are also promotion channels for the Australian spa industry. Because of the lack of government and academic support, compared with other countries, there are no online or print directories that specialise in listing Australian spas. As for spa-based consumer magazines, there is only Spa Life. Contrasting with the traditional spa industry, the Australian spa industry tends to employ more emerging marketing strategies, such as word of mouth, public relationships, and information centres. In addition, loyalty schemes and database mining are essential strategies for the managers’ marketing toolbox (Voigt et al., 2010).

4. Analysis Following a discussion of the differentiated strategies used by the Australian spa and wellness tourism operators — according to the clear distinction between the development environment in Europe and that in Australia — it is also found that Australian spa hoteliers can learn some lessons from the European professions. First, the top priority is to increase the professionalism and excellence amongst those delivering a spa and wellness experience (Puczko and Bachvarov, 2006). A common error that hoteliers make when trying to put a spa together is to assume that therapists have the same values as hotel staff — this is not always the case (Webster, 2004). Integrating the spa therapists into the hotel organisational culture is essential when estab-

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.2.

lishing a new service concept. Second, there is a need to leverage today’s core values of family, connections, experiences, and self-fulfilment when branding a wellness tourism image for the product. Products should include family and friends’ programmes and communicate the idea that leisure is more than merely free time. Next, customisation is a great competitive edge. It is also significant for establishing a customer information database, because the humanistic service is the trump card for success owing to the nature of the business. Finally, spa hoteliers should present professionalism and credible information and have regard for the feedback received to upgrade the customised service constantly and improve the customer experience.

4.1. Development Environments Its convenient and central location enables Australia to become the hub of world tourism, and an increasing number of spa tourists want to experience the Australian spas. The colourful and diverse culture from Eastern and Western countries, in addition to the Aboriginal culture, can be recognised as powerful attractions for international spa tourists. ‘International tourists with an interest in Eastern spirituality, who might be anxious about travelling to Asian countries or concerned about language barriers, may perceive Australia as an ideal safe destination to pursue the interest’ (Voigt et al., 2010, p. 109). However, there are still some concerns about the commercialisation of the Aboriginal culture and the unbalanced distribution of the spa tourism profits. Because of the lack of spa traditions, Australia does not have enough heritage architecture that could be used as a competitive advantage. Therefore, as a newcomer to the global spa industry, Australia faces many challenges. Nevertheless, it is also believed that the relatively new Australian spa industry is full of youthful spirit and has many unique features that offer different and attractive spa experiences to visitors. Moreover, the absence of a strong heritage of spa tourism in Australia may have facilitated the rapid development of other models of provision (Monteson and Singer, 2002). The national and state tourism bodies’ involvement in developing successful spa tourism destinations is critical for controlling and standardising the quality of the wellness tourism products (Sheldon and Park, 2009). Without government and policy support, the development of the Australian spa industry will slow down, and without a powerful spa industry association, the Australian spa industry will lose guidance, protection, and cooperation opportunities. The stable economy of Australia provides the spa industry with powerful support and assists it in overcoming the global financial crisis. The spa industry could even benefit from the global financial crisis, because spas can be an important outlet for the crisis (Tourism Victoria, 2004). However, the rapidly growing economy has led to the constant growth of the Australian dollar exchange rate, which will be detrimental to the tourism industry as well as the spa industry.

4.2. Differentiation Strategies The nature-based location of the Australian spa resorts is a significant attraction for spa visitors. Health geographers have recognised ‘place’ as a determinant that could contribute to people’s health (Hoyez, 2007; Lea, 2008). However, many of these locations are not serviced by public transportation, which is inconvenient for visitors without private cars. In addition, the long distances to the rural areas would increase the cost of the logistics and the commuting of the employees and visitors. Relaxation-based spa experiences have proved a successful strategy for the Australian spa industry. However, the lack of customised services will lead to the loss of some higher-demand spa consumers. Another controversial issue is the regulation of the minimum stay. From the provider’s point of view, the mandatory minimum stay could derive extra revenue from the relatively narrow client base, but visitors prefer no minimum stay, because this could affect their perceptions and

2.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

experiences. Additionally, the retail of spasâ&#x20AC;&#x2122; own products could increase the gross profit margins and increase brand loyalty (Voigt, 2009).

Because of the relatively smaller client base, the Australian spa industry focuses on its target potential market and uses the Internet to promote its services and products. This approach has proved very successful. However, the absence of professional spa magazines will constrain the development of the Australian spa industry. Furthermore, there is no distinct Australian spa tourism brand, either for the domestic or for the international tourists, so it is a challenge for the Australian spa industry to promote itself.

4.3. Recommendations As an emerging market, the Australian spa industry in its preliminary stage still has great potential for growth if appropriate strategies are adopted. First, professional and integrated guidance for the spa operations must be used in framing a brand image as a guarantee of quality and trust. Second, it is essential to provide exclusive quality products to meet the needs of differentiated customers, including corporate group visitors in addition to leisure customers. This also requires innovative marketing strategies to maintain the relationship with the business partners and meanwhile enlarge the leisure clientele base, such as families and young couples. Next, to enhance the business, a solid team with years of proven experience in spa services is important (Barraclough, 2011). Employee training programmes to cater for staff shortages, especially those with crosstrained skills, also need to be upgraded; the changing service products need to be customised for different customers. What is worth mentioning is that the industry bodies stand in need of a lobby in the tourism organisations to develop a strategic plan for resource allocation and to reform the current accreditation and rating system (Voigt, 2009). Various levels of stakeholders in the Australian spa industry have room for improvement and it often requires combined efforts to reach the same goal. Spa providers should pay attention to the effect of their actions on the local communities and environments. Sustainability is a core part of the development of the Australian spa industry, which emphasises balance and harmony between the spa resorts, the local Aboriginal communities, and the natural resources. Without the constraint of the traditional spas, the Australian spa industry could develop its own special spa services and products, and reach more potential customers. An effective national or state industry association should be established to provide guidance and cooperation opportunities for the members. In addition, the Government should consider the spa industry as an important contributor to the national economy and offer support. The stable currency policy would be beneficial for Australian spa tourism, which could maintain the price advantage and attract more international spa tourists. To overcome the transportation difficulties, the Government could extend public transportation, and spa resorts could provide pick-up services. Australian spas could label themselves as relaxation and recreation spas. Spa service providers could also develop individual tailored programmes and offer greater flexibility regarding the minimum stay. Lastly, more Australian spa professional magazines or publications should be created.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.2.

5. Conclusions This paper has discussed the differentiated strategies used by Australian spa hoteliers to increase their visitation and revenue. Considering the differentiation in terms of location, marketing segments, and development environment compared with the professions overseas, Australian spa hoteliers have begun to realise the significance of shifting the focus to leisure customers, because spa tourism is not only a complementary promotion for employees used by corporate managers, but also a fashionable way for family customers to escape from their daily routines. The future trend should be to direct more of the marketing resources towards domestic customers; this will require the coordination of several regional tourism bodies to build a persuasive and compelling wellness tourism image. It is believed that the current governance and planning of the spa tourism industry is far from satisfactory and a new industry body is needed to be responsible for providing best practice business models and introducing a standardised accreditation system. The association will establish a recognised self-regulating system, standardise self-management actions, promote equal competition between hotels, raise the integrated staff training levels, and defend the integrated benefits. In conclusion, the key message regarding expanding the Australian spa hotel industry is to strengthen the cooperation through entirety planning and standardisation. This paper has identified the advantages of the Australian spa industry, such as the convenient locations, colourful cultures, creative services and products, and powerful economic support. Some shortfalls in the Australian spa industry are also illustrated, such as the absence of a spa tradition, inefficient government and policy support, lack of a proficient management method, and no effective promotional channels. Furthermore, sustainable development, creating its own brand of Australian spa tourism, the establishment of a powerful national spa association, and productive management are other important issues for the future development of the Australian spa industry. In the future, studies could focus on spa tourism in order to collect more comprehensive and precise data to investigate the development trends in the Australian spa industry

References Australian Tourism Export Council, 2008, Destination: health. Australia and the global medical travel sector, ATEC, Sydney. Barraclough, J., 2011, Oasis an indulgence, Wyndham Weekly, 16 March, p. 28. Bennett, M., King, B., Milner, L. 2004, The health resort sector in Australia: a positioning study. Journal of Vacation Marketing, Vol. 10(2), 122-137. Burkett, L., 2007, Medical tourism: concerns, benefits and the American legal perspective, Journal of Legal Medicine, Vol. 28(2), 223-245. Goodrich, J. N., Goodrich, G. E., 1987, Health-care tourism: an exploratory study, Tourism Management, Vol. 8(3), 217-222. Hall, C. M., 1992, Adventure, sport and health tourism, in Weiler, B., Hall, C. M. (eds.), Special interest tourism, Belhaven Press, London, 141158. Henderson, J. C., 2003, Healthcare tourism in Southeast Asia, Tourism Review International, Vol. 7(3/4), 111-121. Hoyez, A. C., 2007, The 'World of Yoga': the production and reproduction of therapeutic landscapes, Social Science & Medicine, Vol. 65(1), 112-124. Intelligent Spas, 2008, Spa industry intelligence newsletter: Australia and Thailand spa benchmark report, Retrieved 09/04/2011, from http:// www.intelligentspas.com/newsletter/Newsletter_I230807M.asp. Lea, J., 2008, Retreating to nature: rethinking â&#x20AC;&#x2DC;therapeutic landscapesâ&#x20AC;&#x2122;, Area, Vol. 40(10), 90-98. McNeil, K. R., Ragins, E. J., 2005, Staying in the spa marketing game: trends, challenges, strategies and techniques, Journal of Vacation Marketing, Vol. 11(1), 31-39. Monteson, P., Singer, J., 2002, Planning and operating a resort-based spa, Journal of Leisure Property, Vol. 2(4), 358-368.

2.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Puczko, L., Bachvarov, M., 2006, Spa, bath, thermae: what’s behind the labels? Tourism Recreation Research, Vol. 31(1), 83-91. Research International, 2009, ISPA 2008 global consumer study, Research International, United Kingdom. Roy Morgan Research, 2009, Health and wellness tourism, Unpublished report. Sebastian, I., 2002, Health & spa tourism, Spa Australasia, Vol. 13, 36-43. Sheldon, P., Park, S. Y., 2009, Development of a sustainable tourism destination, in Bushell, R., Sheldon, P. (eds.), Wellness and tourism: mind, body, spirit and place, Cognizant, New York, 99-113. Smith, M., Kelly, C., 2006, Holistic tourism: journeys of the self? Tourism Recreation Research, Vol. 31(1), 15-24.

Smith, M., Puczkó, L., 2008, Health and wellness tourism, Butterworth-Heinemann, Oxford. Starr, L. M., 2006, Launching your line, Retrieved 11/04/2011, from http://www.americanspamag.com/americanspa/Launching-YourLine/ArticleStandard/Article/detail/608387. Tourism Victoria, 2004, Victoria’s spa and wellness tourism action plan 2005–2010, Tourism Victoria, Melbourne, Victoria. Voigt, C., 2009, A comparison of three groups of wellness tourists: exploring benefits sought, health-promoting behaviours and positive psychological well-being, University of South Australia, Adelaide. Voigt, C., Laing, J., Wray, M., Brown, G., Howat, G., Weiler, B., Trembath, R., 2010. Wellness and medical tourism in Australia: supply, demand and opportunities, Sustainable Tourism Co-operative Research Centre, Gold Coast. Webster, J., 2004, Spa quality, Caterer and Hotelkeeper, Vol. 193(1), 64-67.

Author’s Contacts TIMOTHY JEONGLYEOL LEE | timothylee728@gmail.com

Ryokan Facilities in Japan Compared with Spa Hotels in Australia

2.3. TIMOTHY JEONGLYEOL LEE * BORAM LIM **

* PhD, Ritsumeikan Asia Pacific University (Tourism and Hospitality Management). ** School of Tourism, University of Queensland.

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.3.

Abstract 84 In recent years, there has been growing public recognition that the wellness phenomenon is becoming a way of life and reshaping the way we live. The tourism industry is also receiving an impact, without exception, from wellness. In particular, many tourism products are claiming to stand for wellness tourism, such as yoga tourism and therapy tourism, and are attracting tourists. Spa tourism is widely seen as the most representative product in terms of the level of development or popularity. In this respect, this essay will analyse the spa industry of two developed countries, Japan and Australia, in the tourism sector. In addition, it will explore a suggested successful case of spa facilities operation within accommodation facilities.

Key words: Spa industry, Ryokan (Japanese traditional inn), Australian hotel industry.

2.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1. Introduction ‘Wellness tourism is defined as the sum of all of the relationships resulting from a journey by people whose primary motive is to maintain or promote their health and well-being. These people stay at least one night at a facility that is specifically designed to enable and enhance people’s physical, psychological, spiritual and/ or social well-being’ (Voigt, 2009). With the rise of wellness tourism via health tourism for treatment, the spa industry has experienced substantial development over recent years. As a result, it has reached a sufficiently mature stage to discuss its qualitative advantages over its quantitative ones (Tabacchi, 2010). Spas are no longer luxury additional options but have become a crucial criterion when people choose a hotel or any other accommodation (Mandelbaum and Lerner, 2008). Accordingly, the common concern of spa tourism is how effectively each operator manages its spa facilities, differentiating them from others. Moreover, it is imperative to discover what makes spa operations successful and how to overcome the challenges faced by successful operators in advanced countries. This paper compares two countries: Japan and Australia. Japan is often quoted as one of the prime leading industrial countries in the world and its spa tourism is also well developed. It has a unique natural environment and has ryokan, the traditional form of accommodation, with spas. Meanwhile, Australia is famous for its well-developed tourism industry and has a high demand for spa tourism despite lacking natural hot springs. Initially, this paper compares similar levels of accommodation that provide spas in the two countries; however, considering the history and characteristics of ryokan, it attempts to compare ryokan in Japan with hotels in Australia. To compare the two kinds of accommodation, this paper will describe firstly the background of their development, secondly the challenges they face today, and lastly the differentiating strategies within the context of accommodation with spas. This paper draws on the growing literature offering practical and empirical insights into the differences and similarities between two countries regarding accommodation with spa facilities. Furthermore, it provides two case studies and an interview with the on-site supervisor of the hotel in order to add credibility and concreteness. Historically, a strong desire inherent in human nature is to stay healthy physically and psychologically and this has led to a constant demand for bathing and catering spots since the ancient Roman Empire (Hall, 1992). In European culture, spa tourism emerged much earlier than mass tourism, and spa tourism was a means to treat the body and to escape from stressful daily life (Bennett, King, and Milner, 2003). Although it started in certain European countries that have natural hot springs, such as Vichy in France and Baden Baden in German, the spa culture moved rapidly into the US, Asian countries, and even Australia. According to the International Spa Association (ISPA), the total worth of the spa industry is estimated to be over US$60.3 billion (Stanford Research Institute, 2008) and it ranks with golf, cruise tourism, and health clubs in the ‘wallet share’ aspect. Even though the recent economic recession has brought a temporary regression to the worldwide spa industry, all the relevant economic figures show that its current situation is gradually becoming stabilised (Tabacchi, 2010).

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.3.

2. History of spas and accommodation in Japan Japan has a number of natural mineral springs because of its geographical characteristics. The number of registered Japanese natural mineral springs is estimated to be about 3,000 and the number is still gradually increasing; therefore, it ranks number one in the world (Guichard-Anguis, 2007). In Japanese history, the record of spa usage can be traced back to about a thousand years ago and relevant artefacts have been found in various places (Guichard-Anguis, 2001). Thanks to the abundant natural resources, anyone in Japan was allowed to use and bathe in close spots with hot springs. In accordance with this trend, it was natural that diverse forms of spa accommodation developed around the hot springs: for example, ryokan, shukubo (cheap lodging in Buddhist temples), and tojiba yado (regular self-catering inns with spas). Over time, the variety of traditional accommodation merged into the present ryokan, which came to represent a Japanese traditional lodging, combining spa facilities and accommodation (Guichard-Anguis, 2007).

2.1. Development of ryokan Ryokan is a unique accommodation system that exists only in Japan. As mentioned above, the Japanese created an exotic type of accommodation shaped by the natural environmental conditions, which include a number of volcanoes and hot springs. Ryokan usually consist of three main services: sleeping on a tatami (a Japanese floor mat), bathing in spa facilities such as hot springs, and dining in Japanese traditional costumes. This structure dates back to the feudal period in the seventeenth century and todayâ&#x20AC;&#x2122;s services started in the eighteenth century when travelling commenced (Fitzpatrick, 2006). After the construction of the railway in the Edo period from the seventeenth to the nineteenth century, Japanese domestic tourism started to flourish and paved the way for the expansion of the lodging industry. The development of traffic varied the purposes of travelling and greatly contributed to making spa destinations the most popular domestic tourism spots. The advances in traffic allowed various kinds of inns to develop and thus created the present-day ryokan by combining the advantages of successful inns, such as hatago (inns with full service) and honjin (inns with the best services). As the traffic system became more developed, ryokan substantially increased in terms of quantitative and qualitative development and thus attracted more Japanese tourists, such as married couples enjoying their honeymoon or mass tourists from certain companies or groups (Guichard-Anguis, 2007). Nowadays, although ryokan are classified as a level of inn in terms of terminology, their prices and service qualities are diverse, ranging from tourist class to luxury hotels. With regard to operation, most were previously operated by sole owners, but there is a move toward operation by professional operators and massive capital (Guichard-Anguis, 2007).

2.2. Challenges In recent years, as we know, the global economic recession has led to a slight downturn in the tourism industry. Due to this recession, the ryokan industry has experienced a decline as well. To be more exact, Japan has been in economic downturn for about 15 years since experiencing substantial economic growth in the past. In the meantime, between 1991 and 2003, more than half of the business owners operating ryokan have closed their business. Due to this downturn, the number of ryokan operators has dropped sharply from about 100,000 to 45,000 and the general rate of occupancy only reaches about only 40% (Fitzpatrick, 2006). Additionally, the following problems have been identified by many experts in the ryokan industry: a) inconvenience caused by

2.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

culture and language, b) accessibility, and c) ownership.

Firstly, ryokan have a history of over 1000 years and some of the ryokan have fallen behind in terms of facilities and management. Moreover, they are designed for the traditional Japanese lifestyle of sitting on the floor, which can be uncomfortable for foreign visitors who are accustomed to the Western lifestyle. As Fitzpatrick (2006) pointed out, sleeping on the floor without a bed, bathing in shared spas, and speaking a foreign language are barriers to Western visitors. Secondly, according to Kang, Okamoto, and Donovan (2004), ryokan destinations that were developed near hot springs have relatively poorer accessibility than hotels. There are some exceptions, such as those in the Atami area, which take advantage of their location, but some ryokan are located in remote areas far from cities. Thirdly, as mentioned above, as most of the ryokan started on a small scale with private operators or as family businesses, some of the ryokan operators suffer from financial issues or lack management professionalism.

2.3. Managerial strategies and differentiation strategies Although there are difficulties in the ryokan industry, some cases show that they have managed crises very well and are achieving a more stabilised stage due to a range of strategies. Above all, the ryokan industry is trying to overcome the above-mentioned difficulties based on differentiation strategies emphasising ‘traditionalism’ and ‘physical service’. For example, even though they supply various types of rooms to accommodate Western visitors, they do not forget to keep the three basic traditional forms of ryokan: tatami, spa, and dining services. These enable foreign visitors to experience exotic customised Japanese accommodation. Moreover, this pampering service became the biggest reason why foreign tourists choose ryokan (Kang et al., 2004). In reality, anyone staying at ryokan can experience a dining service served by women wearing kimonos after finishing a bath in the natural mineral springs. However, for visitors who do not prefer tatami, the ryokan made an innovative change, namely, they have not only extra rooms fitted out for the Western lifestyle but also private spa bathing tubs (Fitzpatrick, 2006).

2.4. Case study Atami is a small touristic destination in Japan and it is famous for onsen (hot springs) and ryokan. Basically, Atami is about an hour away by shinkansen (express train) from the centre of Tokyo. Because of its geographic proximity, it has been easy to attract many tourists desiring to enjoy the spas and ryokan from all over the country since the railway was constructed in 1925. However, as most of the ryokan were run by privately owned businesses, they have suffered from financial problems. Lately, relevant experts have pointed out that they have fallen behind in terms of facilities and management professionalism. In order to improve these issues, people involved in the ryokan industry in Atami have started to use the Internet as a promotion method and to help tourists to find relevant information easily. In addition, one of the biggest barriers to enjoying ryokan, communal bathing, has been avoided by transforming the spa into private bathing spaces. Rooms have also been diversified by having half Japanese and half Western-style rooms. Besides, tourism officers in Atami have arranged traditional performances, geisha dances, and weekend events to attract more tourists. As a way of attracting foreign visitors, English websites and guide books have also been created. These efforts to improve outdated management have resulted in a stable rate of reservations. Besides, the ratio of foreign visitors is gradually increasing at the same time (Guichard-Anguis, 2007).

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.3.

3. The current situation of Australian spas in hotels Before examining the current extent of spa facilities in Australia, one must consider that the characteristics of Australia’s geographic environment are different from those of Japan. That is, while there are abundant natural hot springs in Japan, Australia has just a few springs in one area. Given the rarity of the sources of hot springs, it is surprising to discover that the spa culture has developed well in Australia. Accommodation equipped with spa facilities is mostly located in the states of New South Wales and Queensland. Most of the spa accommodation is situated in major cities, such as Sydney and Brisbane (Bennett et al., 2003). According to Voigt et al.’s (2010) study, altogether there are 590 suppliers including day spa operators (262), spa hotel and resorts (201), lifestyle retreats (28), spirituality retreats (83), and a mixed form of business (16). In relation to suppliers, most of them are gathered along the eastern coastline and the proportion per state accounts for 29% (New South Wales), 22% (Victoria), and 22% (Queensland). A total of 28% of spa businesses operate in metropolitan areas, Sydney and Brisbane, and the remainder (72%) are in provincial towns. Regarding hotels with spa facilities, the preponderance is in Queensland, while there are more intensively spiritual retreats and resorts in New South Wales. In addition, most spa products target Australian tourists.

3.1. Development environment In spite of the lack of natural springs, the growth of the spa industry in Australia appears to originate from people’s desire to escape from a stressful routine (Bennett et al., 2003). Accordingly, Voigt et al. (2010) point out that causes like the increased interest in a healthy life, doubt about modern medical treatment, and popularity of spiritual therapies have drawn Western societies into the spa industry. Basically, although the history of spas is long, the field of research in Australian wellness tourism is relatively young and, as such, is still establishing its basic tenets. In addition, the analysis of spa management in accommodation is even younger, so it is difficult to discover relevant case studies. Furthermore, the Australian spa industry comes in three different forms under the name of wellness tourism with different forms of products: namely, spa experiences for the purpose of beauty, visiting accommodation with spas, and holistic experience for retreats (Wray et al., 2010). According to Wray et al. (2010), most spa facilities in Australia follow successful settlement of regional tourism. For example, Byron Bay in New South Wales was in the spotlight in the early 1960s. After that, various hotels and resorts were established in Byron Bay and spas are considered as a way of attracting tourists; as such, the use of spas is not the purpose itself.

3.2. Challenges The recent economic recession has affected the spa industry in Australia, which has experienced a slight downturn. In fact, over recent years, some five-star hotels or luxury resorts have tried to establish fully serviced spa facilities in their venue owing to competition. However, according to an attitude survey towards spas conducted by the ISPA (2009), the reason why people do not visit spa facilities is the cost. As a matter of fact, most people involved in this survey showed economic anxiety towards using spa facilities. There are still many people who think that spa products are expensive and an upscale commodity for ordinary people. Next, a lack of adequate planning and publicity is indicated as a barrier that keeps people from using spa facilities. The ISPA’s survey (2009) focusing on Australian wellness tourists showed that they do not know exactly what sorts of spa services are offered. Moreover, tourists who have never experienced spas as a holistic treatment meth-

2.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

od showed a sense of discomfort toward them as well (Voigt et al., 2010). Lastly, service quality is also pointed out. As we know, Australia has just a few natural springs and does not have a deep historical background in regard to spa bathing. Accordingly, incredulity towards spa services and the newness of the spa culture are indicated as barriers (Voigt et al., 2010).

3.3. Managerial strategies and differentiation strategies In the chapter that follows, we shall see two cases, which are coping with these challenges by following differentiated marketing strategies. One is the case of Byron Bay resort district and the other is the spa facilities in Sofitel Brisbane. Firstly, Byron Bay is one of the destinations loved by Australian tourists. Because of its outstanding natural beauty, the number of visitors is increasing every year. However, its history in regard to spa facilities is not long. Just a few of the resorts, starting with the lodge ‘The Buddha Garden’ in 2003, operate spa programmes. These accommodation facilities focus on a variety of wellness products. That is, when visitors use their spa facilities, the operators supply not only the spas themselves but also relevant service products to enhance their effectiveness. Usually yoga, Pilates, or a detox programme are bundled together as one product. With regard to spa marketing, there is no outstanding cooperation among operators but relatively large operators produce weekly spa magazines, membership programmes, and wholesaler exhibitions in order to promote themselves (Wray et al., 2010). Sofitel Brisbane operates spa facilities called the ‘Stephanie Spa Retreat’. In fact, Sofitel has a contract with the business owner of Stephanie Spa Retreat and all the spa programmes operate alongside the Stephanie Spa Retreat. Vytas Angus (the former FandB supervisor of Sofitel Brisbane) explained that this separated operation has rather enhanced its service quality. Meanwhile, this Sofitel unit is developing package products based on spa services. For instance, it sells a product called ‘a night out with spas’, which comprises a onenight stay in the hotel with a massage in the spa facilities. Sofitel also offers ‘total health services’. For example, when guests use the spa programme, Sofitel serves fresh tuna, sushi, or fresh squeezed juice. In reality, the price of the spa products is relatively higher than that of any other operator. When asked about the reason for the high price, the supervisor stated that it is the differentiating strategy. Namely, offering the finest spa service by differentiating the price and quality is the fundamental marketing strategy.

4. Recommendations While observing the case of Japanese traditional inns, ryokan, the most impressive point is their physical services. Although this paper did not attempt to undertake an in-depth exploration of the services provided in ryokan, serving dinner in a kneeling posture is thought to maximise the respect shown to visitors. However, as discussed above, without enough promotion to foreign visitors, it is hard to attract more tourists. Therefore, it is necessary for ryokan operators to reinforce bilingual training of their employees as well as publishing promotional materials written in English or other languages. Moreover, most ryokan are operated by an owner-operator or a family business, so it is crucial to establish a concrete marketing strategy. As pointed out by Kamata, Misui, and Yamauchi (2009), spa managers should understand the characteristics of visiting tourists, such as nationality, the reason for coming, and what makes them happy or upset about the services. Joining a spa union or making an alliance with other operators can also be a marketing tool. Regarding the Australian spa industry, it was surprising that the demand for and supplies of spa facilities are

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

2.3.

higher than expected. Australia has adverse environmental conditions for developing a mineral spring spa industry. Therefore, spa marketing in Australia should focus on service aspects. In other words, in order to attract spa users, it is necessary to vary the package products and price range. Furthermore, it is necessary to alter people’s perception that spas offer expensive products. In regard to marketing, most spa visitors, 42%, prefer to obtain relevant information from the Internet, so supervisors in charge of marketing should try to provide useful information via the Internet. Meanwhile, as Australian spa products consist mostly of massage by employees, the service quality should be upgraded and feedback from visitors obtained to raise visitors’ satisfaction level (Voigt et al., 2010).

5. Conclusion This paper has shown in-depth observation and comparison of spa operations in accommodation facilities in Japan and Australia. Firstly, it examined the developmental environment and historical background of each. Secondly, it listed some challenges that both countries face and their own unique differentiation strategies. Lastly, suggestions for the development of spa facilities in the two countries were explored. Japan and Australia, as leading countries of the tourism industry, have their own strengths and weaknesses. Japan boasts a long history and a deep-rooted spa tradition. Based on its natural environment, unique pampering physical services have been added to the spa accommodation system. Nowadays, the services in ryokan are a good example of customer satisfaction and many countries are trying to emulate them. Therefore, if the problems of language barriers and managerial professionalism are solved, ryokan could be among the premier tourism products. Meanwhile, Australia has a range of spa facilities. As the demand is high, diverse products and price ranges can attract more people to spa facilities. In addition, the main characteristic of Australian spas is that the services are usually merged into package products. Therefore, if the service quality is well controlled by each operator, a diversity of spa products can be most effective in attracting visitors.

References Bennett, M., King, B., Milner, L., 2003, The health resort sector in Australia: A positioning study. Journal of Vacation Marketing, 10(2), 122-137. Cooper, M., 2007, Introduction: Japanese tourism and tourism past and present. Tourism Review International, 11, 3-8. Fitzpatrick, M., 2006, Ryokan on the rise. Caterer & Hotelkeeper, 196 (June 29-July 5), 34. Guichard-Anguis, S., 2001, From curing and playing, to leisure. Two Japanese hot springs: Arima and Kinosaki onsen, in J. Hendry, M. Raveri (Eds), Japan at play, London and New York: Routledge, 245-258. Guichard-Anguis, S., 2007, Japanese inns (Ryokan) in Atami (Japan) and the shaping of coming ‘traditions’. Tourism Review International, 11, 19-31. Hall C. M., 1992, Adventure, sport and health tourism, in B. Weiler, C. M. Hall (Eds.), Special Interest Tourism, Bellhaven Press, London, 141-158. ISPA, 2009, U.S. Spa Industry Update, [s.l.]: [s.n.]. Kamata, H., Misui, Y., Yamauchi, H., 2009, How to attract more tourists? Tourism Review, 65, 28-40. Kang, S., Okamoto, N., Donovan, H. A., 2004, Service quality and its effort on customer satisfaction and customer behavioural intentions: Hotel and ryokan guests in Japan, Asia Pacific Journal of Tourism Research, 9(2), 189-202. Mandelbaum, R., Lerner, G., 2008, RKF industry analysis: Hotel operators massage more profits from their spa operations, Cornell Hospitality Quarterly, 49(2), 99-104. Motenson, P. A., Singer, J., 2004, Practitioner paper: Marketing a resort-based spa, Journal of Vacation Marketing, 10(3), 282-287. Stanford Research Institute, 2008, The Global Spa Economy 2007, New York. Tabacchi, M. H., 2010, Current research and events in the spa industry, Cornell Hospitality Quarterly, 51(1), 102-117.

2.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Voigt, C., 2009, A comparison of three groups of wellness tourists: exploring benefits sought, health-promoting behaviours and positive psychological well-being, Adelaide, University of South Australia. Voigt, C., Laing, J., Wray, M., Brown, G., Howat, G., Weiler, B., Trembath, R., 2010, Health tourism in Australia: Supply, demand and opportunities. Gold Coast: Sustainable Tourism Cooperative Research Centre (STCRC). Wray, M., Laing, J., Voigt, C., 2010, Byron Bay: An alternate health and wellness destination, Journal of Hospitality and Tourism Management, 17, 158-166.

91 Authorâ&#x20AC;&#x2122;s Contacts TIMOTHY JEONGLYEOL LEE | timothylee728@gmail.com BORAM LIM | bo-lim@uqconnect.edu.au-

PART 3

INNOVATION Focussed CASE STUDIES

Go to Index

Well-Being in Spas: Residents’ and Tourists’ Perspectives

3.1. ANA ISABEL RENDA * JÚLIO DA COSTA MENDES ** PATRÍCIA OOM DO VALE ***

* PhD in Tourism at the University of the Algarve/Faculty of Economics. Professor at the School of Management, Hospitality and Tourism of the University of the Algarve. ** PhD in Management at the University of the Algarve/Faculty of Economics. Professor at the Faculty of Economics of the University of the Algarve. *** PhD in Applied Quantitative Methods to Economics and Business at the University of the Algarve/Faculty of Economics. Professor at the Faculty of Economics of the University of the Algarve.

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.1.

Abstract

In industrialized countries, research on quality of life and well-being has been paying close attention to all the actors interacting in a particular territory, such as public and private sectors, non-profit organizations, and residents. The study approaches two areas of tourism research, quality of life and well-being, on one hand, and perceptions of tourism impacts, on the other, based on the case of Loulé, a municipality in the Algarve region in southern Portugal. It explores how the use of health spas and thermal baths by the destination’s residents improves their well-being, aiming to identify at the same time the extent to which hotel businesses promote and encourage residents to use spas and the latters’ willingness to do so. The results bear witness to the growing interest of spa service providers in promoting them to resident segments and, simultaneously, residents’ low propensity to purchase them. In particular, the findings on residents may be due to the absence of a proactive well-being culture, their feeling of not belonging to those specific social spaces, and more generally the awareness of the difference in being a resident and being a tourist.

Keywords: residents, well-being, quality of life, happiness, spas.

3.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1. Introduction The study of tourism’s impacts on communities has been undertaken substantially over the last decades, focusing mainly on residents’ support of tourism development (Easterling, 2004; Sharma et al., 2008) and on tourism’s impacts on residents’ quality of life (Andereck et al., 2005; Jago et al., 2006; Perdue et al., 1987; Tavar and Lockwood, 2008). The purpose of this study is to analyse the relationship between tourism, health, and well-being (a very complex topic that has been researched in relation to travellers’ motivations and destinations’ facilities) and tourism development impacts on residents’ quality of life, taking into consideration the potential as well as the real use of spa services that were originally created to satisfy tourists’ needs, especially those provided by hotels. In industrialized countries, issues of quality of life and well-being are of great concern to all the stakeholders interacting in a destination, namely place developers and managers seeking to create better and more adequate living conditions for residents, businesses aiming to provide differentiated and customized services to satisfy the wants and needs of customers, non-profit organizations that strive to defend and protect individuals’ legal rights, and finally consumers, either tourists, excursionists, or residents. Moscardo (2010:76) argues that the “discussion to date has been dominated by descriptions of emerging opportunities and services and a focus on niche markets for services such as health and wellness retreats, and medical tourism operation”. In fact, the emphasis so far has been placed on tourists and specific tourism market niches, such as consumers of spa services, while the use of spa facilities by residents is still an unexplored topic in tourism research. This study follows the reflections and conclusions of a PhD research project in the area of tourism and residents’ quality of life and explores how residents’ use of spas and thermal baths may constitute a key element in the improvement of their subjective and objective well-being. Wellness and spa concepts are becoming very popular. Increasing numbers of people are demanding wellness experiences and hotels are broadening their range of services accordingly to meet their wants and needs. In addition, spa parlours and wellness centers are appearing every day in the business arena, while thermal spas are in the process of updating and equipping their venues to accommodate a wider range of services, adapted to meet the aspirations of the new spa-goers. Spa-goers are now considered to include all those purchasing spa services, whether they are tourists or residents in want of regeneration. The research in progress studies residents’ perceptions of tourism impacts on their quality of life, exploring to that effect the constructs of quality of life, happiness (a subjective dimension including emotional and community well-being), and life satisfaction (an objective dimension comprehending material, health, and security well-being). The frequency and type of contact with tourists, the economic and professional dependence on tourism, and the level of tourism development in the residence area are assumed to be determinant factors in

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.1.

the explanation of residents’ perceptions of tourism. This paper describes the methodological approach adopted in the PhD research, namely the triangulation of methods used in the exploratory stage of the research (which comprises interviews, participant observation, and collection of information), the questionnaire design and the methodological principles underlying it, and the fieldwork carried out in Loulé with residents. The study discusses the use of hotel spas by residents, aiming to identify the extent to which hotel businesses promote spa services to residents and the residents’ willingness to use them. In addition, it intends to be a starting point for reflection on and understanding of residents’ positive and negative attitudes towards hotel spas concerning the interaction with tourists and the influence on personal well-being.

2. Literature Review The literature review focus stems from the scientific areas of psychology, tourism sociology, tourism anthropology, and tourism geography (Andereck et al., 2007; Andrews and Withey, 1976; Butler, 1980; Cummins, 1996; Diener, 1984; Gursoy and Rutherford, 2004; Jurowski and Gursoy, 2004; Ko and Stewart, 2002; Lankford, 1997; Moscardo, 2009; Pizam, 1978; Sirgy, 2001; Veenhoven, 2000, 2005). Concerning the constructs of quality of life and residents’ well-being, the study explores the following topics: the perceptions of and attitudes towards the tourism phenomenon; the process of tourism development and tourism industry growth; the social processes and relations within the host community and between tourists and the tourism industry; the socio-cultural changes in the host community and local identity; and the process of acculturation and lifestyle. It is widely acknowledged that tourism has a significant impact on destinations and is a powerful agent of social and economic change. Research has shown that tourism generates more positive effects than negative ones on both destinations and resident communities; however, the participation of stakeholders is essential because they all contribute to the destination’s success. Currently, there is wide concern among tourism industry professionals and scholars over destination sustainability due to the changes that tourism development causes in destinations and host communities. Still, it is necessary to understand further how these changes really affect sustainable tourism development and particularly the life of residents. Many authors devote their efforts to the study of the relationship between sustainable tourism development and residents’ attitudes (Gursoy and Rutherford, 2004; Jurowski and Gursoy, 2004; Ko and Stewart, 2002; Perdue et al., 1987), and some of them adopt the social exchange theory point of view (Homans, 1961). The social exchange theory claims that residents’ attitudes towards tourism depend on the level of its development at the destination, and individuals select exchanges after having assessed the costs and benefits involved. According to Pizam (1978) and Turner (1986), residents who perceive the actual or potential value of tourism and believe that the costs do not exceed the benefits will favour the exchange and consequently be supportive of the development efforts. Jurowski and Gursoy (2004) show that attitudes towards tourism are influenced by residents’ perceptions of economic, social, and environmental impacts, but also by the perceived potential use of recreational resources. The literature review shows that tourism improves communities’ quality of life by generating employment opportunities and infrastructures; however, it also highlights its negative effects, such as an increase in traffic,

3.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

the crime rate, and the cost of living (Andereck et al., 2005, 2007; Ap and Crompton, 1993; Belisle and Hoy, 1980; Dyer et al., 2007; Gursoy and Rutherford, 2004; Jurowski and Gursoy, 2004; Perdue et al., 1987).

Residents’ attitudes and perceptions are also studied in relation to the residence area’s proximity to the main tourism area (Gursoy and Rutherford, 2004; Jurowski and Gursoy, 2004; Lankford, 1997; Sheldon and Abenoja, 2001). Belisle and Hoy (1980) argue that distance affects the perception of tourism impacts significantly, though small variances are observable in the opinions expressed, suggesting that all groups of individuals acknowledge tourism’s direct and indirect benefits. The authors also note, as Gursoy and Rutherford (2004) do, that the initial stage of tourism development contributes to a positive attitude towards tourism. The contact frequency with tourists (Sheldon and Var, 1984) and both the destination’s economic dependence and its professional dependence on tourism are relevant factors in studies focusing on residents’ attitudes. In general, the research confirms the positive relationship between individuals’ economic dependency on tourism and their overall attitude towards it (Pizam, 1978); in other words, individuals connected to employment in the tourism area are more willing to support tourism development. In addition, there is wide consensus among researchers (Moscardo, 2009) on the main components through which quality of life is classified and measured: basic physiological needs, security, belongingness, and self-esteem. However, Moscardo (2009) emphasizes the need to develop a more succinct approach to the construct in the context of tourism. The World Health Organization defines quality of life as “individuals’ perceptions of their position on life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (WHO, 1994:5). Veenhoven (2005:61) claims that quality of life “can be measured by how long and happy people live”. Both definitions refer to the dimensions included in this study. Some authors studying quality of life issues adopt a general approach to the construct (Cummins, 1996; Diener and Suh, 1997; Jurowski and Gursoy, 2004), while others explore specific topics, such as happiness (Veenhoven, 2000) and life satisfaction (Andrew and Withey, 1976). Sirgy (2001) points out that happiness has an emotional nature and that life satisfaction has a cognitive one with self-evaluation against a certain standard of one’s life and accomplishments. Veenhoven (2005) defines happiness as the degree to which an individual judges favourably his/her overall quality of life. In order to understand how residents perceive their own quality of life, but also how they relate it to tourism development, it is necessary to identify the dimensions that residents connect to and use to assess their well-being. Subjective well-being is not merely the absence of negative factors; in fact, it includes an overall judgement because it lies in the individual’s life experience (Diener, 1984). Subjective well-being is understood as a general state of “well-being” and Veenhoven (2005) claims it to be the degree to which an individual judges the overall quality of his/her life as a whole in a favourable way. Diener and Suh (1997:191) argue that a holistic study on quality of life should integrate both objective and subjective well-being indicators. In fact, the literature review suggests that there are various dimensions of well-being, according to objective and subjective elements. The well-being domains considered in this study are organized into four groups, as proposed by Sirgy (2001): (i) material well-being, including house ownership, stable employment, and income (Andrew and Withey, 1976; Cummins, 1996); (ii) community well-being, such as community life, integration, and social participation; (iii) emotional well-being, which explores the affective dimension of life, namely love and family life (Andrews and Withey, 1976); and (iv) health and safety well-being, like the absence of sickness or a feeling of security in the residence area (Andrew and Withey, 1976).

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.1.

3. The Municipality of Loulé – A Case Study The Algarve is a region in the south of Portugal and one of the most internationally well-known Portuguese destinations due to its position since the 1960s as a sun and beach destination. More recently, it has stood out as an international and very popular golf destination. The different stages of tourism development in the eleven parishes of the municipality of Loulé (see Figure 1), the geographic, socio-cultural, economic, and environmental diversity, and the central location in the Algarve region make this municipality a very interesting case study. Figure 1 | Parishes of the Municipality of Loulé

Source: http://www.flickr.com

The Algarve region is divided into three sub-regions (see Figure 2). Litoral, or the seaside, is the most prominent area and has plenty of natural resources and tourist attractions. It has high population density and a great diversity of accommodation, restaurants, and all tourism-related services. Most residents work in the service sector and generally are very tolerant of tourists due to the presence of diverse cultures in the region. In this attractive area, associated with a perception of lifestyle quality, natives live together with people of various nationalities and cultures, usually foreign residents and immigrants. Barrocal is a sub-region located between the seaside and the low mountain range, and is an emerging tourism area, as it is gradually replacing traditional activities with tourism. It is characterized by a village lifestyle and traditional practices that coexist with new experiences resulting from the presence of some tourists and foreign residents, but also from the proximity to the coast. Subsistence agriculture and livestock activities and production can still be seen; however, they currently exist only as a complement to the service businesses operating in the towns of Loulé and Faro or, more generally, along the coast, where most residents work in the tourism industry. Finally, the low mountain range, called Serra, has low population density and almost no tourism activity and production. It is a territory in progressive desertification due to low employment opportunities, isolation, a harder climate and more adverse physical conditions to livability. The main economic activities in Serra are

100

3.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

forestry, livestock (goats, sheep, and pigs), and the production of traditional cheeses, sausages, and the highly appreciated spirits from arbutus. Figure 2 | Sub-Regions of the Algarve

101

Source: http://sapiens.no.sapo.pt/m-carsico/enquad-geomorf.htm

Similarly to other tourism destinations, the region, and therefore LoulĂŠ, experiences problems of seasonality, dependence on outbound markets, and the effects of early decades of unplanned tourism growth. However, in recent years, the public and private sectors have been working to create better conditions to improve the international and competitive position of the region, designing and developing strategic tourism products, such as sun and beach, wellness tourism, meetings and congresses, nature tourism, and golf tourism. There are also signs of efforts being made to create new touristic areas related to authentic and unique tourism experiences.

3.1. Thermal Spas in the Algarve The thermal offer in Portugal is concentrated mainly in the northern region above the Tejo River. In southern Portugal, the only thermal unit available is Caldas de Monchique. Located in the Algarve region, this unit includes a broad range of health care and wellness treatments in a modern thermal spa and excellent accommodation (see Figure 3). In the Monchique area, there are emergent nature tourism activities and gastronomy programmes. Figure 3 | Thermal Spas in Portugal and the Algarve

Source: http://www.termasdeportugal.pt

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.1.

Despite this fact, in the Algarve, and particularly along the coastline and integrated into 4- and 5-stars hotel units, there is a wide range of spas, designed to offer wellness experiences, and some of them include thalassotherapy services located near the sea. Indeed, the region offers seawater-based treatments to aid relaxation and restore the physical balance, particularly at high-profile resorts, such as Vilalara Thalassa Resort. Figure 4 | An Experience – The Algarve Spa Week

102

Source: http://www.algarvespaweek.com/index_en.php

The Algarve Spa Week (see Figure 4) is an event that began in 2010, which developed in association with some of the best hotels of the region, and it is communicated both to tourists and to residents. The website states that “The experiences and special offers are available to all, hotels guests and local residents.” The message is the hoteliers’ answer to the necessary diversification of spa users, but also an opportunity for residents to benefit from the region’s excellent infrastructures. Residents can access spa services with 50% discount, which is a real opportunity to enjoy a space usually developed to meet tourists’ needs. This business orientation is meant to increase spa consumption by residents and consequently to improve their well-being and quality of life.

4. Methodology The research methodology of this study adopts a qualitative and quantitative approach. In order to ensure the results’ reliability, a triangulation of methods was developed. This strategy allows the comparison of different types of information such as semi-structured interviews, participant observation, and the collection of information from existing documents. Exploratory semi-structured interviews were conducted with community stakeholders with the support of an interview guide and field notes were taken. The interviewees were the parishes’ presidents (11), presidents of non-profit organizations (6), local companies’ managers (2), opinion leaders (3), and residents in the study area (13). Most interviews took place in person, had an average duration of one hour, and were not recorded. A form was created in Google Docs and sent to individuals who chose to answer by e-mail. It asked, for example, how they feel about tourism and how they face tourism in their own space, how they accept tourists with different nationalities, and how they perceive the touristic activity’s impact on their residence area and on their own quality of life. Very important topics in these interviews were the difference between well-being, happiness, and life satisfaction, their contribution to the overall quality of life and to the liveability of the desti-

3.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

nation, and well-being culture and spa use by residents. Those interviews were assumed to be very important for collecting more detailed information and opinions on the research topics. The participant observation activities were carried out discontinuously in time and space. The selection of observation moments concerned the observation of daily life and of special occasions in the parishes, which, by their own nature, implied the coexistence of residents and tourists or visitors.

103

Documents and information were collected in the parishesâ&#x20AC;&#x2122; offices and during the interviews, owing to the fact that some interviewees provided diverse published materials or other relevant compiled information. In the next stage, the questionnaire was designed to include questions on nine dimensions of quality of life and associated with the constructs of life satisfaction and happiness, as shown in Figure 5. It was thus composed of a section on quality of life, happiness, life satisfaction, and well-being; a section on the dimensions of tourism impacts (economic, social, cultural, and environmental); a section on personal important variables, such as socio-demographic features, and also on residence area proximity, type and frequency of contact with tourists, and economic and professional dependence on the tourism sector. A five-point Likert scale was used in the questionnaire and residents were asked to rate the level of importance of and/or satisfaction with the given factors. Figure 5 | Survey Design â&#x20AC;&#x201C; Quality of Life Dimensions

relationships acess to goods and services

community participation

leisure time hapiness

quality life of satisfaction life

residence area

work

health

house

security

The questionnaire was tested in February 2011 and subsequently applied in March and April 2011 through direct administration in strategic places of the 11 parishes of LoulĂŠ to a sample of 1049 Portuguese residents above 18 years old. The sampling method, stratified sampling, was chosen taking into consideration the geographic distribution of residents (distributed between the coast and the inland areas) and the stage of tourism development of each area (see Table 1).

3.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Table 1 | Sample Definition and Distribution by Parishes Parish

Sample Total

Male

Female

Almancil

156

Alte

Ameixial

Benafim

Boliqueime

Quarteira

286

141

145

Querença

Salir

São Clemente (Loulé)

255

124

131

São Sebastião (Loulé)

119

Tôr

1049

520

529

TOTAL

The questionnaire implementation was carefully coordinated to ensure greater reliability in the data collection. Thus, the survey application was conducted by five individuals who participated in a meeting held to give them the necessary information on Loulé and its residents, to convey the standard procedures in questionnaire application, to locate them in the proper places, and to provide them with the questionnaire forms and relevant guidance for implementation. The data analysis methods used included a confirmatory factor analysis, statistical tests to ensure the reliability of the study’s indicators, and a structural equation model with latent variables.

5. Results and Discussion The exploratory study conducted so far indicates that the use of spas is increasing, in harmony with the growing interest in spa treatments. Individuals who visit spas seek to improve their physical and psychological condition, want to escape from daily life and to relieve or reduce stress, and favour a holistic approach to well-being (i.e. understanding, serenity, self-acceptance). They need to improve their sense of well-being, recover after illness, and/or practice fitness activities through which they can keep in shape and maintain a healthy lifestyle. The profile of spa customers varies according to their motivations and interests; therefore, there are consumers who visit spas for fun and others who enjoy occasional pampering or consume specific services to relax or to find serenity, beauty, or help. The diversity of motivation shows that spa consumers may be tourists but also residents, especially those who live in busy urban areas. The interviews with hoteliers and residents highlight the growing interest of the former in promoting spas to segments of residents and the low propensity of residents to access hotels providing spa services. The findings suggest that there is a lack of a proactive well-being culture among residents in this area; they

104

3.1.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

experience a sense of not belonging to hotels with spa services, despite their location in the residence area, and perhaps for that same reason; in short, they appear to perceive a difference between being a resident and being a tourist.

105

The exploratory study reveals that Loulé’s residents acknowledge the benefits of spa treatments but at the same time they are not frequent consumers of spa services. However, they also recognize their increasing interest in spa-related benefits, and the demand has been increasing in recent years. Most of them do not feel that they can use hotel spas because the services are perceived to be too expensive relative to their purchasing power. In many cases, residents claim: “This is only for tourists.” In fact, they are not very comfortable with the idea of sharing the same space with tourists, as they have a sense of not belonging to it but also of inferiority in relation to tourists.

6. Conclusions This PhD research reveals that the topic of residents’ well-being and quality of life in the context of spa consumption is capturing the attention of scholars and tourism business managers. The growing concern about physical and psychological health stimulates the use of spas by residents in destination areas and the wide range of spa treatments available contributes to the increase in consumers’ attention and interest. The new market environment provides hoteliers with the stimulus to promote their services to prospective consumers, including residents, assuming that the benefits derived from spa services contribute to the development of the host community’s quality of life. However, some difficulties seem to be hard to overcome, namely the low propensity of residents to access spa hotels, as they appear to prefer urban centre spas, and the absence of a well-being culture among residents as well as a sense of belonging to spa spaces. Further analyses of the collected data using descriptive statistics and estimating a structural equation model will allow a deeper understanding of how the well-being and quality of life of residents may be improved in harmony with tourism development. It will also be possible to investigate how the emotional, community, and health well-being may be determinant in the perception dimensions related to quality of life and to assess the role of spas in this context.

References Andereck, K., Valentine, K., Knopf, R., Vogt, C., 2005, Residents’ perceptions of community tourism impacts, Annals of Tourism Research, 32(4), 1056–1076. Andereck, K., Valentine, K., Vogt, C., Knopt, R., 2007, A cross-cultural analysis of tourism and quality of life perceptions, Journal of Sustainable Tourism, 15(5), 483–502. Andrew, F., Withey, S., 1976, Social Indicator of Well-Being, Americans’ Perception of Quality of Life, Plenum Press, New York. Ap, J., Crompton, J., 1993, Residents’ strategies for responding to tourism impacts, Journal of Travel Research, 32(1), i47–50. Belisle, F., Hoy, D., 1980, The perceived impact of tourism by residents: A case study in Santa Marta, Columbia, Annals of Tourism Research, 7, 83–101. Butler, R., 1980, The Concept of a Tourism Area Cycle of Evolution: Implications for Management of Resources, Canadian Geographer, 24, 5-12. Cummins, R. A., 1996, Assessing quality of life, In R. I. Brown (Ed.), Quality of Life for Handicapped People, Chapman & Hall, London. Diener, E. D.,1984, Subjective well-being, Psychological Bulletin, 95, 542–575. Diener, E. D., Suh, E., 1997, Measuring quality of life: Economic, social, and subjective indicators, Indicator Research, 40, 189–216. Dyer, P., Gursoy, D., Sharma, B., Carter, J., 2007, Structural modeling of resident perceptions of tourism and associated development on the Sunshine Coast, Australia, Tourism Management, 28, 409–422.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.1.

Easterling, D., 2004, The residents’ perspective in tourism research: A review and synthesis, Journal of Travel & Tourism Marketing, 17(4), 45–62. Gursoy, D., Rutherford, D., 2004, Host attitudes towards tourism – An improved structural model, Annals of Tourism Research, 1(3), 495–516. Homans, G., 1961, Social Behavior, Harcourt, Brace & World, New York. Jago, L., Fredline, L., Derry, M., 2006, Tourism in small communities: Risk and benefits, Tourism Review International, 10(1–2), 91–101. Jurowski, C., Gursoy, D., 2004, Distance effects on residents’ attitudes toward tourism, Annals of Tourism Research, 31(2), 296–312. Ko, D., Stewart, W., 2002, A structural equation model of residents’ attitudes for tourism development, Tourism Management, 25, 521–530. Lankford, S., Williams, A.L., Knowles-Lankford, J., 1997, Perceptions of outdoor recreation opportunities and support for tourism development, Journal of Travel Research, 35(3), 60–65. Moscardo, G., 2009, Tourism and quality of life: Towards a more critical approach, Tourism and Hospitality Research, 9(2), 159–170. Moscardo, G., 2010, Searching for well-being: Changes in tourism motivation and behaviour at an iconic destination, in Book of Abstracts of the Travel and Tourism Research Association Europe 2010 – Budapest “Health, Wellness and Tourism: Healthy Tourists, Healthy Business?” Perdue, R., Long, P., Allen, L., 1987, Rural resident perceptions and attitudes, Annals of Tourism Research, 14, 420–429. Pizam, A., 1978, Tourism’s impacts: The social costs to the destination community as perceived by residents, Journal of Travel Research, 16(4), 8–12. Sharma, B., Dyer, P., Carter, J., Gursoy, D., 2008, Exploring residents’ perceptions of the social impacts of tourism on the Sunshine Coast, Australia, International Journal of Hospitality and Tourism Administration, 9(3), 288–311. Sheldon, P., Abenoja, T., 2001, Resident attitudes in a mature destination: the case of Waikiki, Tourism Management, 22(5), 435–443. Sheldon, P., Var, T., 1984, Resident attitudes to tourism in North Wales, Tourism Management, 5, 40–47. Sirgy, M., 2001, Handbook of Quality-of-Life Research: An Ethical Marketing Perspective, Kluwer Academic Publishers, Netherlands. Tavar, C., Lookwood, M., 2008, Social impacts of tourism: An Australian regional case study, International Journal of Tourism Research, 10, 365–378. Turner, J., 1986, The Structure of Sociological Theory, IL: The Dorsey Press, Chicago. Veenhoven, R., 2000, The four qualities of life – ordering concepts and measures of the good life, Journal of Happiness Studies, 1, 1–39. Veenhoven, R., 2005, Apparent quality-of-life in nations – How long and happy people live, Social Indicators Research, 71, 61–68. World Health Organization – WHOQOL GROUP, 1994, Versão em Português dos Instrumentos de Avaliação de Qualidade de Vida, Organização Mundial De Saúde/Divisão De Saúde Mental, Retrieved January 19, 2010 from http://www.ufrgs.br/Psiq/whoqol1.html.

Author’s Contacts ANA ISABEL RENDA | arenda@ualg.pt JÚLIO DA COSTA MENDES | jmendes@ualg.pt PATRÍCIA OOM DO VALLE | pvalle@ualg.pt

106

Thermal Tourism Through the Audiovisual Sector – A New Tool for Promotion: The Case of Ourense, Thermal Capital

3.2. NOELIA ARAÚJO VILA * JOSÉ ANTONIO FRAIZ BREA ** ADRIANA FRAIZ GARCÍA ***

* Visiting professor of the Business Administration and Marketing Department at the University of Vigo. Bachelor’s degree in business administration; PhD student of tourism management and planning. ** Professor of the Business Administration and Marketing Department at the University of Vigo. Doctor in Economic and Business Sciences. *** Bachelor´s degree in tourism; master’s degree in tourism management and planning; PhD student in tourism management and planning.

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.2.

Abstract Thermal tourism and the audiovisual sector have become two important components of the entertainment industry in recent years. From both a recreational and health aspect, thermal tourism and various audiovisual products are significant elements of present-day consumers’ leisure time. Despite both fields being able to cooperate in order to obtain synergies, they have independently evolved at a considerable rate, since consumers of both are not mutually exclusive, i.e. the same consumer can show an interest in both the audiovisual sector and thermal tourism. An excellent opportunity is therefore presented for spa establishments and destinations to reach a large number of potential customers through placement and exposure in audiovisual products, especially films and fiction series. As an example, the spa capital Ourense will be studied, a city seen by thousands of viewers through two fiction series of high recognition.

Keywords: thermal tourism, audiovisual, fiction series, promotion, Ourense

110

3.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

111

1. Introduction: Twenty-First Century Consumers’ Interest in Leisure The present century is characterized by rapid and continuous change. As such, consumers nowadays have gone through several transformations and evolutions that have led to the appearance of a new behaviour profile – one that is totally different from those of the previous century. The production system and consumption has undergone a series of changes since the turn of the century. This has led to an evolution in consumers’ habits, trends and needs, resulting in a consumer characterized by demand and activity. With regards to consumption in the service sector – particularly in fields closely related to leisure and entertainment – this behaviour manifests itself when someone makes a large number of trips while buying the least number of tickets, or when one enjoys the most number of cultural and artistic events without investing more money in theatre, cinema or concerts (Gershuny, 2005: 11). In other words, the manner of consumption has changed, as well as its location and the method of payment. Sometimes it is even difficult to separate the diverse spheres of work, personal time and leisure, thereby entering into a continuous interrelation. There is no doubt that the development of technology and an immersion in the information era has favoured this change, especially with the initiation and swift establishment of the Internet. This allowed consumers to gain access to information much faster, and meant they became more knowledgeable of the products or services they were interested in (López, 2009: 12). These factors explain this level of demand and activity, whereby continuous information searches, blog comments, websites and forums enable consumers to be completely aware of everything they buy, and thus demand to receive or be offered some added value, such as a guarantee or after-sales services. Although better access to information and enhanced evaluations of technology have been relevant factors in the creation of this new form of consumer, it cannot be confirmed whether this is the decisive reason for their emergence. A number of other changes have also played a part; for instance, a psychological transformation in which the consumer no longer seeks social visibility, but rather psychic comfort (status, beauty, elegance, independence, etc.) (López, 2009: 12). In the words of Vicente Verdú (2006: 126) “every buy is presented less as expenditure than as a spiritual input”. In the case of Spain, these factors also include economic changes (economic growth and better work conditions after the end of the Franco era), demographic changes (population rise – mainly due to immigration – increases in the number of households, changes in family units, age factors), education changes (better access to higher education) and even changes in the products themselves (i.e. products’ life cycle). Nowadays, products with a short life cycle have become fashionable – the so-called “one-time-used” products – such as those of the fashion industry or new technologies (López, 2009: 13). The potential customer is conscious of these variations which affect their behaviour when consuming a product/service.

3.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

It should be mentioned that within these new trends and habits – the result of the mentioned factors – interest has arisen in leisure and its surrounding industry, a consequence of the previously mentioned “working fast to live slow”. In this process, several activities and actions come into play when trying to revaluate the positive identity of recreation and optimize one’s available spare time (De la Villa, 2009: 47).

2. The Audiovisual Sector as Part of the Leisure Industry From the appearance of cinema at the hands of the Lumière brothers (or other pioneer inventors from different countries – the attribution is not entirely clear) at the end of nineteenth century – which can thus be considered the beginning of the audiovisual period – to the present day, the sector has undergone some noticeable changes. It all started with a revolutionary invention and an incipient promotional campaign: the initial “kinetoscope” of Edison (Jeacle, 2009: 682) was adapted to form the Lumière brothers’ most well-known cinematographe, which then began being exhibited not only in scientific centres, but also during public holidays, first in Paris and later the whole world. The process was simple: all that was needed was a projector, a white sheet and some benches (Gray, 1996: 12). As the competition quickly increased, with many magicians trying to benefit from the invention and its art, an industry initiated (Santa Eulalia, 2006). After creating his “camera-projector”, one Lumière brother said of cinema: “I usually do not frequent it. If I had predicted it would have finished like that, I would never have invented it” (Santa Eulalia, 2006). In the decades that followed the appearance of the first films of the Lumière brothers, this sector has experienced a significant expansion, reaching fields beyond cinema such as television, video and the world of multimedia we currently live in, which contains the Internet, video games and interactive television, among others. It is a sector that is particularly important in the current economy, not only for the sector itself, but also for its strong and direct links with other sectors, particularly technology, computer science and telecommunications; its own expansion encourages the development of these other sectors and vice versa, resulting in significant synergies (Martí and Muñoz, 2001: 124). Within the leisure industry (in which this sector may be included), its strong position is noticeable: in Spain alone, audiovisual, cinematographic, and radio and television services have a combined revenue of over 23 billion euros, and employ some 154,334 people (INE, September 30th 2006) (Table 1). Table 1 | Turnover and Leisure Industry Employment in 2006 Turnover (euros)

Staff Employed (as of 30/09)

Audiovisual services

11,677,425,000

77,167

Motion picture and video

4,268,712,000

32,224

Radio/television activities

7,408,172,000

44,943

Recreational, cultural and sporting activities

17,825,964,000

282,706

Arts and entertainment

3,716,114,000

90,197

Sports activities

5,260,695,000

95,961

Activities of news agencies, libraries, museums, gardens and other recreational

8,849,155,000

96,548

Source: Personal compilation based on INE (2006)

112

3.2.

113

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Therefore, it seems clear that this is a leading sector at both national and international levels, and a strategic sector in terms of economies with mid- to long-term expansion prospects (Fernández, 1998: 40). However, an important part of its success and growth prospects will depend on one factor that is currently most influential in this area: new technology. The biggest change the sector faces is its inclusion in digital markets i.e. film, series or programme distribution via non-conventional media (i.e. not cinema or television). Despite advertising profits proving to be minimal, and the purchase of television series through authorized portals such as iTunes being negligible, the Internet has established itself as a new method of distribution (Benzal, 2009: 40). With this in mind, the evolution of the audiovisual sector can be analysed from three dimensions (Feijóo, Fernández-Beaumont, Gómez-Barroso, Marín and Rojo-Alonso, 2007: 277): social, technological/economic and commercial (see Table 2). Table 2 | Audiovisual Sector Dimensions Dimension

Changes

Factors

SOCIAL

Greater interest to society

- Cultural pluralism - Increased education - Protection of human rights

TECNOLOGICAL/ ECONOMIC

New models approach, especially new technologies and the digital market

- Digital TV - High-definition TV - Interactive TV

COMMERCIAL

Increased competitiveness

- Competitive level

Source: Personal compilation based on Feijóo et al. (2007)

2.1. Concept and Current Subsectors in the Audiovisual Sector To a certain extent, we have been talking about the audiovisual sector in an intuitive way, without making reference to a definition of it. We will begin by making reference to the term “audiovisual” as defined by the Spanish Royal Academy (RAE): “what is referred to as hearing and sight taken together, or used at the same time. This is specifically stated in reference to educational methods that make use of acoustic recordings accompanied by optical images”. This definition suggests there needs to be concurrent visual and hearing elements in order for a medium to be considered audiovisual; therefore, strictly speaking, radio is not a part of this sector. However, most authors and studies consider radio to be a part of the sector, specifically “the inclusion of fixed images as paintings and photographs, moving images as films, television and videos, and sounds recordings, the voice or other sounds, or as a component resulting from moving documents in the image” (Turner, 2010: 84). If we move beyond the word, and instead consult a definition of “the audiovisual sector”, this can be understood as “the production and distribution of films, radio and television activities, and recording studios” (European Commission, 1993: ch. 27). Due to the era in which it was written, this definition does not include multimedia services. But the importance of this area has obviously proliferated since this time. This is why, in the last decade, some authors working in this field have considered multimedia services as part of this industry, defining it today as “the whole of heterogeneous markets taking part directly or indirectly in the simultaneous provision and reception of sound and moving images” (Martí and Muñoz, 2001: 126). Using this definition as

3.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

a starting point, the audiovisual sector would now include the following subsections (in terms of products): cinema, television, video/DVD and multimedia, while excluding radio and musical recordings (and new formats such as audio podcasts) (Table 3). The table highlights how the included fields are numerous, and the products within these similarly abundant. Therefore, we will reduce the scope of this study to just two of them. Firstly, we will analyse cinema itself. And secondly, we will look at an audiovisual product which has become the star product of the TV, video/DVD and multimedia sector in the last few years – the fictional series.

114 Table 3 | Audiovisual Sector Classification AUDIOVISUAL SECTOR CLASSIFICATION Activity

Cinematography

Television

Video/DVD

Multimedia

Creation of contents

Cinema production companies

Cinema and TV production companies

Software enterprises and video games

Provision of services

Exhibition rooms

TVs; content integration

Film distributor

Editors; content integration; telecommunication operators

Transmission / Distribution

Movie industry distributors

Telecommunication operators: terrestrial, cable, satellite

Stores and video clubs

Online - The Internet: interactive television

TVs; videos; audio systems; satellite dishes;s decoders

TV sets; videos; DVDs; audio TV sets; personal systems computers; video game consoles; DVDs

Transmission systems; network infrastructure; optical and audio equipment; etc

Equipments for content duplication

Equipment for consumers (manufacturers)

Equipment for producers and distributors (manufacturers)

Room equipment, optical equipment and audio, photographic laboratories; others

Off line - CD ROMDVD

Equipment for content duplication

Source: Personal compilation based on Martí and Muñoz (2001)

3. The Appearance of Synergies Between the Tourism Sector and the Audiovisual Sector: Cinematographic Tourism and Tourism Through Audiovisual Series The product par excellence in the audiovisual sector has for many years been cinema. Ever since it first emerged as the foremost product in the audiovisual sector, it has been the first to be used by other sectors who wish to benefit from its influence. For example, tourism benefits from both increased visits and interest in a destination after a destination is seen in a product of the audiovisual sector, particularly cinema and TV series (both fictional and factual). Due to the proliferation of new technologies – particularly the Internet – the diffusive power of feature films or TV show is gaining in significance; this means that a destination or location achieves a greater number of potential consumers/tourists. Moreover, followers of films or series feel a special bond with the show’s setting, and become interested in the actors, shooting locations or other destinations associated with it. The enthusiasm these products unleash is evidenced in figures related to downloads, television audiences and box-office sales.

3.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

This is not a particularly new phenomenon: many feature films promoting a certain destination have been released since the appearance of cinema, and from 1970 until 2000 a number of TV series linked to specific locations were very successful. A series of researches have been carried out into the impact feature films and TV series have on the destinations depicted (Table 4), thus proving the degree of influence they have on consumers.

115

Table 4 | Visitor Impact Due to Feature Films or Fictional Series Feature Film/ Series

Location

Impact on the number of visitors or income from tourism

Breaveheart (1995)

Wallace Monument, Scotland

300% increase

Captain Correlli´s Mandolin (2001)

Cephalonia, Greece

Approx. 50% over three years

Four Wedding and a Funeral (1994)

The Crown Hotel, England

No vacancies during three years

Mission Impossible 2 (2000)

National Parks in Sydney

200% increase

Notting Hill (1994)

Kenwood House, England

10% increase in a month

Pride and Prejudice (2005)

Lyme Park in Cheshire, UK

150% visitors

Sense and Sensibility (1995)

Saltram House, England

39% increase

Troy (2004)

Canakkale, Turkey

73% increase

Lyme Park

178% increase in visitors after its broadcast on the BBC

Sudbury Hall, Derbyshire (indoor scenes)

In 1996 visitors increase by 59% compared to 1995

Southfork Ranch, Dallas

500.000 more visitors per year

Boston

Equivalent to 7 million of dollars of promotion

Miami

German visitor numbers grow by 150% between 1985 and 1988

Pride and Prejudice (1995)

Dallas (1978-1991) Cheers (1982-1993) Miami Vice (1984-1989)

Source: Hudson and Bren (2006:389); Busby and Klug (2001: 320)

Within the tourist industry’s different classifications – including cultural breaks, beach holidays, business, sport, alternative, adventure or social tourism, among others – a new subgroup has appeared as a result of the union between cinema and tourism (although this may be included in cultural tourism, which is the largest subsector with the greatest possibility of expansion). This subsector is at its very peak due to actual economic and social trends. Here we include cinematographic tourism, which can be understood as “the leisure activity linked to geographic locations related to cinema” (Campo and Fraiz, 2010). A product closely related to cinema has emerged in recent years, which has positive indicators of its future success: the audiovisual series. It is not a recent product either, since its appearance is associated with the 50s soap operas. It is a product that has returned to its former glory since the turn of the twenty-first century, thanks no doubt to the appearance of new distribution channels. We therefore find ourselves faced with two products of the audiovisual sector which are currently at their zenith: feature films and audiovisual series. These products are similar in a number of ways, the most important of which is their ability to arouse the viewer’s interest in tourist destinations after being seen in a multimedia experience (visual and audio). The difference between the two products is that the former is a punctual experience and the latter shows a certain temporality and continuity (which makes audiovisual series a more addictive and long-lasting product with which viewers form closer bonds). For this reason, it is possible to contextualize the situation of fictional series and their impact on tourist destinations by first looking at cinematographic tourism, as this modality can be considered its predecessor (even if they are both now coexisting). Furthermore, image representations of tour-

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.2.

ist destinations via communication media such as cinema, television or even literature have become influential when deciding on a vacation destination (Iwashita, 2006), so there is a common ground for both varieties. Audiovisual language is a way of approaching reality in an undercover manner (García, 2005), since all types of communication are used in cinema and fictional series, as well as television at a broader level: “oral language, written, musical, plastic, corporal or any other human symbolization of reality” (Prada, 2002). This transforms the audiovisual product into an experience that makes feelings emanate from an audience; indeed, its capability of spreading and expressing emotions turns it into a great communication medium (Ferrés, 1995). Consequently, it becomes not only an excellent product that is an integral part of the current economy, but also an ideal opportunity or means of introducing viewers to certain destinations and tourist resources.

4. Cinematographic Tourism and Fictional Series Applied to Thermal Tourism The benefits of a tourist destination’s appearance in cinema or fictional series can be justified by the tourism sector of that destination, since the filming location is one of the audience’s most valued items, together with places where the plot is developed, cities where important film companies are located, areas related to actors´ lives, as well as directors, producers and screenwriters, and museums and other resources (Campo and Fraiz, 2010). A number of parameters should be added confirming the greater communicative effectiveness of placing a product (in this case a destination) in a feature film or fictional series over traditional publicity. • The viewer’s greater involvement through imaginary identification. It takes place within a narrative identification, with characters and facts; that is to say, with “existential conflicts” posed (González, 1999). • Scepticism is suspended; fiction becomes a part of reality. The so-called “reality effect” (González, 1999) consequently affects feelings related with the images and the story (Hellín and Martínez, 2009). • The consumption of experiences through feature films results in an “altered and intensified feeling”, and induces a desire to view images seen on the screen in situ (MacCannell, 2003). It should not be obviated either that the physical environment of a film (including the filming location) relates to the story in several ways. For instance, a passive background curtain (as was used in many western feature films) can act as an integral part of the film plot, as in the case of The Man from Snowy River (1982), where the High Country in Victoria, Australia takes on an important role as friend, protagonist and enemy. More recently, the amazing landscapes of Brokeback Mountain (2005) are key to the plot’s development. Riley and Van Doren (1992) point out that Australian films, which have attracted some attention in the United States, include common elements that may stimulate factors in the travel motivations of American viewers. These are: • The use of natural environments as background curtains and spectacular scenarios of the films’ action. • Interaction and conflict between men and the environment. • A simple lifestyle and way of living.

116

3.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

117

As mentioned, Australian film productions with the greatest impact in the United States during the 1980s all contain important sequences depicting the country’s environmental attributes. The Mad Max films were shot in unexplored areas (100 million dollars collected worldwide); The Man From Snowy River depicted the Blue Mountains of New South Wales (10 million dollars); and Crocodile Dundee (1986) and Crocodile Dundee II (1988) portrayed Kakadu National Forest in the Northern Territory (70 and 57 million dollars, respectively) (Scoll, 1991). Such arguments only serve to support the view that an audiovisual product can promote a film location. As such, the sector has developed this into an ideal tool for particular tourist destinations and natural environments; for instance, thermal tourist destinations or even private film locations, such as thermal establishments, especially spas. There have been several examples of such portrayals in the history of cinema, sometimes in a conscious way and sometimes in an intuitive way (see Table 5). Some examples of this are the feature films The Cure (1917), starring Charlie Chaplin; The Road to Wellville (1994); and more recent cases, such as Balnearios (2002) and Last Holiday (2006); or well-known nationally broadcast fictional series Hospital Central (episodes 5 and 6 of the 14th season, broadcast in 2007), and regional series Padre Casares (episode 78, broadcast on March 1st 2010). Both shot part of these episodes in the thermal town of Ourense, or had scenes in As Termas de Outariz, a thermal establishment of the city. Table 5 | Films and Series Filmed in Thermal Establishments and Destinations FEATURE FILM/SERIES

FILM LOCATION

Plot

The Cure (Charles Chaplin, 1917)

United States

Silent comedy in which the protagonist goes to a spa to recover.

L'Année dernière à Marienbad (Alain Resnais, 1963)

France. Sequences in the In a baroque hotel, a stranger, X, tries to persuade a married woman, A, to leave her husband, M, and run off spa town of Marianske with him. Lazne (aka Marienbad)

Otto e mezzo (8 1/2) (Federico Fellini, 1963)

Italy

Various stories are interwoven around Guido, who has gone to a spa.

Three Women (Robert Altman, 1977)

United States

Surrealistic view of life of an eccentric young girl who is able to adopt the personality and physical appearance of her best friend.

Oci ciorne (Nikita Mikhalkov, 1987)

Italy

Romano Patroni meets a young Russian girl, Ana, in a spa. Thinking she was the love of his life, the unfortunate Romano spends all his time chasing her.

The Unbearable Lightness of Being (Philip Kaufman, 1987)

United States France

Prague, 1965. Tomás, a womanizer and consummate surgeon, is obsessed with the search for happiness.

The Road to Wellville (Alan Parker, 1994)

United States

Anthony Hopkins plays the eccentric doctor, John Harvey Kellogg, a staunch defender of the biological life, who lives in the luxurious spa Battle Creek.

Ruby in Paradise (Víctor Núñez, 1995)

United States

Ruby is a young girl who decides to make a radical change in her life, abandoning her monotone existence in the tough mountains of Tennessee and moving to the thermal station of Palm City Beach, Florida.

Balnearios (Mariano Llinás, 2002)

Argentina

Extravagant and cheerful encyclopaedia and stories of spas of Argentina.

Hotel Danubio (Antonio Giménez-Rico, 2003)

Spain Part of the shooting in the spa of Caldelas de Tui

Galicia, the 1950s. Hugo, a failed writer, is constantly rejected by his editor because his stories do not have an audience due to a lack of credibility. He maintains a relationship with Ivón, a young and beautiful chorus girl of Revue Variety Company.

Source: Personal compilation based on filmaffinity.com, telecinco.es

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.2.

Table 5 | Films and Series Filmed in Thermal Establishments and Destinations (continuation) FEATURE FILM/SERIES

FILM LOCATION

Plot

Bañeros 3 todo poderosos (Rodolfo Ledo, 2006)

Argentina

Three freighters get superpowers and become lifeguards of a spa ruled by criminals from Hong Kong.

Hospital Central (episodes 5 and 6 of 14th seaspm, 2007, broadcast on Tele5)

Ourense Scenes in Termas de Outariz

“Heart that does not feel” and “A Ribeira Sacra”. One of the protagonists (Dr.Vilches) travel to Ourense to meet some friends.

Padre Casares (episode 78, 2010, broadcast on the regional TV of, TVG)

Ourense Scenes in Termas de Outariz

“Thermal waters and spiritual exercises”. The physician of the parish priest, Mr. Crisanto, advises him to relax in Ourense, Galicia’s capital of thermal tourism.

Source: Personal compilation based on filmaffinity.com, telecinco.es

5. Promotion of Thermal Destinations through Fictional Series: The Location of Ourense, Thermal Capital in Hospital Central and Padre Casares 5.1. Methodology and Objectives The city of Ourense in Galicia is famed for its thermal potential, as can be seen in its slogan, “Ourense, thermal capital”. The city is characterized as an area with “water, rivers, fountains, and especially, thermal waters”, which run from Las Burgas (spring thermal and mineral-medicinal water that emerges at 67ºC) in downtown Ourense, to the numerous springs which flow along the banks of the Río Miño, of which several have been developed into pools. These so-called pozas can be both public – e.g. A Chavasqueira, O Tinteiro, O Muiño and Outariz – and private – e.g. A Chavasqueira and Outariz (turismodeourense.com). The managing public bodies of the city – aware of its potential as a tourist destination – have wanted to project the city’s image overseas, and so developed a diverse range of promotional tools in order to do so. One of these is the facilitation and arrangement for the shooting of some TV series episodes in the city – as well as a feature film, Los Girasoles Ciegos (2008) – so as to enable the diffusive power of the media to attract potential tourists. Hospital Central and Padre Casares are two recent examples of well-known TV series with national and regional areas of impact that have filmed in Ourense. The aim of the present research is to answer the following questions: • What image of the city is projected to the viewer, and thus the potential tourist? • What impact does the broadcast have on the city (measured in number of visitors and overnight stays)? In order to answer the first question, it must be preceded by a content analysis of the episodes of both series filmed in the city: episodes 5 and 6 of the fourteenth season of Hospital Central (broadcast in October 2007) and episode 78 of the sixth season of Padre Casares (broadcast in March 2010). Finally, a descriptive analysis of the city’s number of visitors and overnight stays is conducted from 2006 to 2010, emphasizing the month the series was broadcast, and deciding on whether the series had a positive impact on the city in relation to tourism increasing.

118

3.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Figure 1 | The Thermal Waters of Ourense

119

Source: turismodeourense.com

5.2. Analysis and Results 5.2.1. Content Analysis of Hospital Central and Padre Casares

Hospital Central is based around the experiences of a group of physicians and medical staff, as well as on the patients who visit their hospital. It has been on the air since 2004, and is now in its 19th season (2011). It has exhibited high ratings since it was first broadcast, and averaged a 28.2% audience share in its first year on the air (2004). In 2006, the viewing figures stabilised around the 28% mark, and have dwindled ever since, although it still generally receives more than 16% of the audience share. The two last series (2010–2011) have had the lowest audience figures (between 11 and the 18% of the audience) (formulatv.com). The most important scenes in the series are filmed in its own studios in Madrid, and outdoor filming tends to be scarce, so the appearance of Ourense in two episodes provides more value to an unusual fact. The two episodes filmed there – episodes 5 and 6 of the 14th season – obtained audience ratings of 25.2 and 23.7%, respectively (formulatv.com), meaning Ourense was exposed to more than 9 million viewers. Images of the Las Burgas and Termas de Outariz are broadcast, and the dialogue emphasizes the quality of the water there, as can be seen in the dialogue between Dr. Vilches and the friend he visits in Ourense: Friend: (in front of the fountain of the Las Burgas) Touch, touch. Vilches: (with his hand in the water) Damn, it burns! Friend: I have already told you, it is said that nobody is able to keep his hand in the water during half an Our Father. Vilches: I am sure it is not natural. You heat it up? Friend: No, no, it is the earth itself which does it. Our waters are really good for rheumatism, arthritis and asthma. (Episode 5, 14th season; minutes 42:09 – 42:44).

3.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Figure 2 | Hospital Central Filming in Outariz (Ourense)

120

Source: formulatv.com

It should also be added that there was a great deal of publicity (both paid and unpaid) generated before the dates of broadcasting through publications in the press, and official and unofficial websites and blogs for the series. Padre Casares is a comedy series that has been broadcast on regional channel TVG since 2008, and which is now in its seventh season. The plot revolves around Father Horacio Casares, who has been educated in a modern Jesuit seminary, before arriving in the small town of Louredo in order to replace the old father, Crisanto (official website: http://www.padrecasares.com/). The present and former series exhibited high ratings, with over 30% of the audience share, which made this programme one of the most viewed regional broadcasts in the country in 2008 (vozaudiovisual.es). Given that its broadcasting range is Galicia, such figures involve a viewership of more than 300,000 individuals. Ourense pledged to promote itself through this series due to its outstanding ratings, and featured in episode 78 of the sixth season (broadcast on March 1st 2010): “Augas termais e exercicios espirituais” (“Thermal waters and spiritual exercises”). The synopsis of this episode is focussed on the inability of Don Crisanto to maintain a diet despite his health problems. On the suggestion of Bishop Nogueira, Cristanto is sent to Ourense for a vacation, due to its famed thermal waters (official website of the series). Some key areas of the city are mentioned in the episode, and Las Burgas or Termas de Outariz were chosen again as filming locations. Ourense’s water properties are also mentioned, as well as the slogan of the city, word for word by one of the characters (Amelia) in front of Las Burgas: “Las Burgas, a set of springs, are the most representative element of the city of Ourense, together with the Roman Bridge and the Holy Christ […]. The spring thermal waters are 67ºC […] mineral-medicinal waters. This city is known as the thermal capital of Galicia, having different springs, bridges and pools. A relaxing bath in the waters of its thermae is a pleasure for the senses” (episode 78).

3.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Figure 3 | Filming of Padre Casares in Termas Outariz

121

Source: http://termasoutariz.blogspot.com

After analysing the two series, it can be seen that the city used a similar promotional strategy for both, searching for an image that linked the city to its thermal tourism, and then emphasizing its health component. In both cases, the scenes depict the tourist resources, e.g. Las Burgas (the mineral-medicinal water fountains) and the thermal areas of Chavasqueira and Outariz. The medical properties of the water at Las Burgas are included in the script of both series, reiterating the same characteristics: the high temperature and its healing properties. The aim is that the viewer sees thermal waters as a synonym of Ourense. 5.2.2. Visitor Impact on Ourense

After checking the transmitted image, we now analyse whether the audiovisual product really benefitted the city of Ourense. We have opted for two series with high ratings, at a regional and national level, which means a greater number of potential tourists who have might have received its promotional message. We will now analyse the number of visitors and overnight stays during the months of October (following the broadcast of Hospital Central) and March (after the broadcast of Padre Casares). Table 6 | Number of Travellers and Number of Overnights in Ourense in October (2006-2010) No. travelers

No. overnights

2006

26,756

52,272

2007

28,355

56,340

2008

28,010

52,669

2009

27,344

54,946

2010

29,197

55,145

Source: Personal compilation based on INE (2010)

In the case of Hospital Central, the episodes filmed in Ourense were broadcast on October 3rd and October 10th 2007. In these months, visits to the city increased by 1,599 individuals from the previous October (2006), and the number of overnight stays rose by 4,068, an increase of the 5.96% and 7.78%, respectively. If we compare such figures with ensuing years, October 2007 remains the year with the most overnight stays in that

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.2.

month during the period studied; as the average is around 53,758 (omitting 2007), meaning that yearâ&#x20AC;&#x2122;s figure is more than 2,500 higher than the average (Figure 5). Figure 4 | Overnights in Ourense During October (2006â&#x20AC;&#x201C;2010) Source: Personal compilation based on INE (2010)

122

In the case of Padre Casares, the episode filmed in Ourense was broadcast on March 1st 2010. After comparing the number of visitors and the number of overnight stays from March 2010 with the previous year, we observed an increase of 1,855 visitors and 1,369 overnight stays (8.58% and 3.30%, respectively). The increase in the number of overnight stays is less than expected, since the series is broadcast regionally, and thus viewers are based closer to the destination. If we compare the whole study period (eliminating 2008 as it was a year when Easter fell in March; hence the greater figures), we do not find a significant increase in the number of travellers or overnight stays in 2010, but we do notice a decrease for 2009 (Table 7). This suggests that in order to achieve an increased amount of overnights at a destination, it is necessary for the location to be depicted in an audiovisual product with a certain geographic scope of broadcasting (i.e. national, given that the regional level did not produce a significant effect).

Table 7 | Number of Travelers and Number of Overnights in Ourense in March (2006-2010) No. travelers

No. overnights

2006

22,727

45,237

2007

23,939

48,831

2008

28,442

54,506

2009

21,616

41,507

2010

23,471

42,876

Source: Personal compilation based on INE (2010)

3.2.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

6. Conclusions

123

The numbers related to the audiovisual sector (i.e. the high rates of downloads and large audience figures) and the interest that it generates in viewers inspire some to imitate the way of life depicted on-screen, and make it appealing for other sectors on the lookout for synergies, such as the thermal tourism sector, to promote their own kind of lifestyle – in this case going to spas on a regular basis – in popular television series. In light of this, this medium presents an opportunity for thermal destinations – or tourist destinations in general – to attract a great number of potential tourists through somehow being present in various audiovisual products that have a noticeable impact. An example of this includes feature films (of which some have already shown thermal establishments or destinations, although in many cases this was not an entirely conscious promotion initiative from the tourist destination). Examples include classics such as The Cure (1917) or Ojos Negros (1987), both of which were filmed in spas. We can find more recent examples in local and national audiovisual series. With high viewing figures and large social media followers, these products are at their zenith in the twenty-first century. An example of this is the exposure of Ourense and its thermal waters through two fictional series, Hospital Central, a nationally-broadcast programme with audience shares around the 28% (marking more than 5 million viewers), and Padre Casares, a regional broadcast with audience figures around 30%, which means that it attracts more than 300,000 viewers (and thus an equal number of potential tourists). In this case, the transmitted image of the city is clear and unanimous, coinciding with its advertising slogan: “Ourense, thermal capital”. The impact that these locations had on viewers is obvious in the case of Hospital Central, but not as defined with regards to Padre Casares. In the former, overnight stays in the city notably increased in the month of broadcast (a 7.78% increase on the same month of the previous year); this is not the situation in the second example, in which the number of travellers increased (up 8.58% from the previous year), but not significantly with regards to overnight stays. Even so, both cases managed to increase traveller and overnight figures, suggesting that locating tourist destinations in a fictional series is an effective promotion tool; the higher the audience and the greater the broadcasting area, the greater the repercussions. Despite the above-mentioned examples, there are still very few tourism entities that consciously use the multimedia sector as a channel for the promotion of thermal tourism destinations; due to the high figures of diffusion, thermal destinations and tourism destinations in general are encouraged to use this way of communicating. Note Note: a

preliminary version of this chapter was published as Araújo, V. N., Fraiz Brea, J. A. and García, A. F., Recording in a Spa Desti-

nation (Ourense, Spain): Hospital Central Series: A New Experience for the Viewer, Journal of Tourism Research & Hospitality, 2.1.

References Audiencias Hospital Central, 2011, http://www.formulatv.com/series/8/hospital-central/audiencias/. Benzal, M. A., 2009, Industria audiovisual y mercados digitales, ICADE, Revista cuatrimestral de las Facultades de Derecho y Ciencias Económicas y Empresariales, 78. Busby, G., Klug, J. (2001), Movie-induced tourism: The challenges of measurement and other issues, Journal of Vacation Marketing, 7, 316-332. Campo, L.R., Fraiz, J.A., 2010, Consideraciones estratégicas para la promoción del turismo en Galicia a través del cine, Revista Galega de Economía, vol.19 (2), 2. Comisión de las Comunidades Europeas, 1993, Pluralismo y concentración de medios en el mercado interior, Oficina de Publicaciones Oficiales de las Comunidades Europeas, Luxemburg.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.2.

Compañía de Radio-Televisión de Galicia. http://www.crtvg.es/programas/?m=1&p=317 [19/01/2011]. De La Villa, M., 2009, Ocio bifronte en una sociedad postindustrial, Boletín de psicología, 96, 47-65. Feijóo, C., Fernández-Beaumont, J., Gómez-Barroso, J.L., Marín, A. A., Rojo-Alonso, D., 2007, The emergence of IP interactive multimedia services and the evolution of the traditional audiovisual public services regulatory approach, Telematics and Informatics, 24, 272-284. Fernández, A., 1998, Aproximación al sector audiovisual europeo actual, Cuadernos de CC.EE. Y EE., 35, 39-50. Ferrés i Prats, J. (1995), Televisión, espectáculo y educación, Comunicar, 4, 37-41. Film Affinity. http://www.filmaffinity.com [19/01/2011]. Fraiz, J.A., 1993, La Publicity, ESIC MARKET, 81, 119-131. García, F., 2005, La serie C.S.I. como metáfora de algunas facetas del trabajo científico, Revista Eureka sobre Enseñanza y Divulgación de las Ciencias, vol.2 (3), 374-387. Gershuny, J., 2005, What do we do in post-industrial society? The nature of work and leisure time in the 21st Century”, ISER, Institute for Social & Economic Research, 7. González, J., 1999, El discurso televisivo: espectáculo de la posmodernidad, Cátedra, Madrid. Gray, R., 1996, Cinemas in Britain. One Hundred Years of Cinema Architecture, Lund Humphries Publishers, London. Hellín, P. A., Martínez, S., 2009, Marca turística y movie maps. Identidad, cine y publicidad como producto de consumo, Revista Signos de Consumo, 2, 1-18. Hudson, S., Brent, J. R., 2006, Promoting destinations via film tourism: An empirical identification of supporting marketing initiatives, Journal of Travel Research, vol. 44, 387-396. Instituto Nacional de Estadística. http://www.ine.es [19/01/2011]. Iwashita, C., 2006, Media representation of the UK as a destination for Japanese tourists: Popular culture and tourism, Tourist Studies, 6.1, 59-77. Jeacle, I. (2009), Going to the movies: Accounting and twentieth century cinema, Accounting, Auditing & Accountability Journal, vol. 22 (5), 677-708. López, C., 2009, La nueva era del consumidor, Profesiones, 117, 12-13. Maccannell, D. (2003), El turista. Una nueva teoría de la clase ociosa, Editorial Melusina, Barcelona. Martí, F. P., Muñoz, C., 2001, Economía del cine y del sector audiovisual en España, ICE, Economía de la Cultura, 792, 124-138. Padre Casares, Audiencia capitulo 35, http://www.vozaudiovisual.es/noticias/113-padre-casares-audiencia-capitulo-35.html [19/01/2011]. Padre Casares, http://www.padrecasares.com/[19/01/2011]. Prada Sansegundo, S., 2002, La televisión nos enseña, Revista Electrónica Interuniversitaria de Formación del Profesorado, vol. 5 (4), http:// www.aufop.org/publica/reifp/02v5n.asp. Real Academia Española. http://www.rae.es [19/01/2011]. Riley R. W.., Van Doren, C. S., 1992, Movies as Tourism Promotion: A Pull Factor in a Push Location, Tourism Management, 13.3, 267-274. Santa Eulalia, M.G., 2006, La jactancia de Louis Lumière (Revisión del Nacimiento del Cine), Cuenta y Razón, 140, 143-148. SCOLL, R., 1991, Theatrical rental figures, Motion Picture Association of America. Telecinco, http://www.telecinco.es/hospitalcentral/ [19/01/2011]. Turismo de Ourense, http://www.turismodeourense.com/ [19/01/2011]. Turner, J.M. (2010), From ABC to http: The effervescent evolution of indexing for audiovisual materials, Cataloging & Classification Quarterly, vol. 48, 1, 83-93. VERDÚ, V., 2006, Yo y tú, objetos de lujo. DEBATE.

Author’s Contacts NOÉLIA ARAÚJO VILA | naraujo@uvigo.es JOSÉ ANTONIO FRAIZ BREA | jafraiz@uvigo.es ADRIANA FRAIZ GARCIA | adri_fg@uvigo.es

124

Health and Wellness in the Guadaíra Basin, Spain

3.3. JESÚS RAÚL NAVARRO GARCÍA * FREDERICO ALVIM **

* PhD in History and Master’s in Landscape Protection, Management and Planning, School of Spanish-American Studies and Spanish National Research Council (CSIC). ** Spanish National Research Council (CSIC).

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.3.

Abstract Located in the polluted basin of Guadaíra’s river (Andalusia, Spain), Pozo Amargo’s mineral spring spa is a good example of a rich architectonical heritage related to water that inhabitants have created over the last few centuries. Like the nearby river, this site has suffered neglect, but both the citizens’ movement and the response of the Administration of the Autonomous Government of Andalusia have made possible the mitigation of both situations. Nowadays, the restoration of the former spa can be an exciting initiative that joins the improvement of the environmental and landscape value of the Alto Guadaíra with the recovery of the artistic and ethnographic heritage of this area. Moreover, it might launch a pioneering experiment of a landscape project applied to a tourism and health destination able to generate wealth in the area.

Keywords: Guadaíra valley, thermalism, spa, landscape, health.

128

3.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

129

1. Introduction: Twenty-First Century Consumers’ Interest in Leisure Thermal towns are usually enclaves of great natural beauty and landscapes that do not go unnoticed by users and travellers who visit these destinations to find relief for their illnesses and ailments, attracted by the qualities of their waters and landscapes.1 Considering the importance of the landscape established in the European Landscape Convention as a contributing factor in improving citizens’ quality of life, the purpose of our work is to explore the history of how, since the eighteenth century, the landscape has contributed to the growing, renowned acclaim of the curative qualities of mineral waters, and how one of the most common activities at these locations is for bathers to observe and enjoy the landscape.2 Consequently, it makes perfect sense to associate the recovery of an old spa with a plan for the management and planning of the surrounding landscape.3 It seems quite convenient for us to integrate landscape policies in the rural development policies that promote thermalism, given the importance of the landscape as a significant element affecting people’s quality of life and their physical, mental and spiritual well-being. This importance becomes even more relevant for health-oriented tourist destinations, such as those where thermal tourism thrives. Landscapes have extremely restorative capacities for human beings. Nevertheless, we have not been able to determine what type of landscape has the greatest restorative capacity. Some claim that natural landscapes offer us a greater feeling of well-being than urban landscapes do (theory of attention-related restoration); other authors link this restorative capacity to landscapes that reflect the historical-cultural development through which they have been created; others opt for landscapes related to leisure activities; and finally, other authors point to the restorative capacity of landscapes that provide relaxation and the opportunity for human beings to find themselves spiritually. Based on all this criteria, we can affirm that few landscapes have greater restorative capacities than thermal destinations, considering their location in privileged natural environments, their rich historical-architectural heritage, their traditional association with leisure activities, and the way in which they have been carefully maintained since the eighteenth century, ensuring the proper conditions to offer bathers’ respite and help them recuperate their state of mind. The surrounding landscape of spa facilities is therefore not only aesthetic, but also incorporates an important cultural aspect, which can propagate much more than feelings of well-being. The social construction of the restorative capacity of thermal landscapes has been carried out since antiquity through the work of writers, filmmakers and travellers, as well as memFor example, it is common for one of the first chapters of a spa construction project to be dedicated to the landscape (Calavia Santos, 1918). One of the most frequent activities at spas is to observe the landscape from nearby roads, hotel rooms, poplar groves and resting benches, from which the river, the gardens and the mountains come to life: “there is a shady poplar grove in front of the porches, with benches where bathers can rest, tired from spending the morning in the water. Magnificent intermittent thickets of hydrangea provide decoration, and below you can see the eternal river with its immovable waters, the red shimmering rooftops and the mountains’ silhouette” (Azorín, 1929: 23, 27-28). 3 This article is part of the project “Andalusia-Latin America: cultural exchanges and transfers,” HUM 03215, financed by the Regional Government of Andalusia and cofinanced by the European Regional Development Fund (ERDF). 1

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.3.

oirs written by doctors.4 Thermal towns amass cultural heritage, landscape quality, natural environments and a comprehensive, modern concept of the term health. In Spain, the construction of large spa facilities, complementary buildings and accompanying gardens contributes to the creation of spaces appropriate for rest and relaxation therapy. Urban (or even “artificial”) landscape elements are incorporated in what we could colloquially call natural and rural landscapes, and solutions are offered for the necessary adaptation of the physical environment in order to provide medical services while simultaneously introducing natural elements such as gardens around the water that become the fundamental element of the thermal landscape’s layout. These facilities must allow users to consider the location a “possible utopia” and the landscape is extremely important for the thermal environment to acquire its utopian dimension – a utopian dimension that these landscapes actually possess to some degree. Above all, the most renowned thermal towns are especially connected to local culture in terms of landscape, but not only in this respect (Luginbühl, 2008). This communication between physical environments in thermal towns, which are fundamentally rural (immersed in nature) or urban (small towns with thermal complexes), must emphasise the harmony of the final result: “mixed” landscapes where nature is urbanised and becomes naturalised again, resulting in thermal towns with an enormous potential in the wealth of the landscape. Urban planning for these beautiful thermal towns must be respectful, not only of the significant heritage they possess from a hydrological, architectural and landscape perspective, but also of the thousands of bathers who visit them because of the qualities of their waters and the natural and cultural surroundings, which help improve their quality of life and state of well-being (Moyano and Priego, 2009). This interaction, which has been noted by some authors, between active and passive environments is the basis of our proposal, which is also very much in tune with new health trends that consider people’s health as affected by their habits and life styles. This new concept of health as defined by the World Health Organization (WHO) is clearly incorporated in the offerings of thermal towns, which are associated with an extensive history that brings together cultural heritage, landscape quality and a comprehensive, modern concept of health that is closely related to the concept of philosophical, social and ecological harmony between humanity and the landscape (Bedell, 2010: 192-201; Durand, 2010), as the great anarchist and geographer Élisée Reclus predicted throughout his extensive career in the nineteenth century.

2. The Guadaíra River Basin and Pozo Amargo The Guadaíra river basin has for many years been the focus of constant protests and social demands triggered by serious water contamination and an abandonment of the rich water-related cultural heritage. The Administration of the Autonomous Government of Andalusia initiated plans for the lower and middle river basin (located primarily in the cities of Alcalá de Guadaíra and Morón) which have mitigated these problems to a certain degree; however, the upper river basin (Ordóñez, s.d.: 111-118; Programa, 1999; Programa, 2006),5 These works include the literature of authors such as José Luis Sampedro (El Río que Nos Lleva), Teresa Viejo (La Memoria del Agua), Manuel Vázquez Montalván (El Balneario), Pardo Bazán (Un Viaje de Novios), Pío Baroja (Desde la Última Vuelta del Camino), Benito Pérez Galdós (La de Bringas, La Familia de León Roch, Fisonomías Sociales), José María de Pereda (Sotileza, Nubes de Estío, Los de Becerril), Manuel Vicent (El León de Ojos Verdes), Armando Palacio Valdés (La Hermana San Sulpicio), Fernando Schwartz (Vichy, 1940), Azorín (Veraneo Sentimental), Carmen Martín Gaite (El Balneario), and Thomas Mann, Dostoyewski and Henrik Ibsen, among many others, as well as the films of directors such as Berlanga (Los Jueves Milagro), Fellini (8½), Gorris (The Luzhin Defense), Resnais (Last Year in Marienbad), Mikhalkov (Dark Eyes), Nieto Zas (La Perrera), Altman (Three Women), Birkin (Burning Secret), Charles Chaplin (The Cure) and the French Jacques Tati. Equally important is the role played by landscape schools in Galicia and Catalonia which had a major influence on the creation of a national sentiment through thermal architecture. 5 Water quality is the fundamental concern, as seen in Programa, 2007, La Contaminación, 2008 and La Industrialización, 2006. 4

130

3.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

131

which is uninhabited and plagued by the aforementioned problems, remains unaffected by these protective policies despite its rich natural and cultural heritage, which deserves to be discovered and protected before it degrades even further. The Guadaíra upper river basin has an interesting thermal enclave: Pozo Amargo. This is the most interesting case of the urban planning of a spa in the history of the province of Seville (although today it pertains to the province of Cadiz) (Reina, 1993 and 1994). Considering the importance of integrating the “thermal water” resource in the local productive system, we will study how the spa’s recovery can help preserve the cultural and natural heritage of the upper Guadaíra region (Pozo, 2000). We are aware that in proposing the reopening of curative mineral water springs we must integrate landscape and environmental policies in order to preserve the water’s potential as an engine for economic recovery, and restore Pozo Amargo’s identity as a thermal town and the river basin’s historical role as a quality water provider to the metropolitan area of Seville – to maintain and enhance, that is, the symbolic link with water and its unquestionable distinguishing character. We are currently working on a proposal for an action plan for the town of Pozo Amargo and its surroundings. Based on its value as an example of the region’s traditional architecture and recovery of the use of its curative mineral waters, we will attempt to determine the benefits of preserving what is left of the town and conserving the area’s traditional rural architecture, nearby salt mines, archaeological heritage, surrounding mountain landscape and the Guadaíra upper river basin, as well as the curative mineral water springs. The intention is to recover and revalue definitively the outstanding historical, hydrological, sociocultural and artistic heritage of the privileged environment surrounding old spas as spaces associated with health, tranquility and enjoyment of the landscape (Leboreiro, 1994). Pozo Amargo is unquestionably part of the general history and urbanisation of spas in Spain since ancient times as sites associated with health, hygiene and socialisation, as well as architectural and urban projects (Malissard, 2001). The classic thermal baths have been adapted to a much more modern spa concept, which began to take shape with the Enlightenment in Spain and nineteenth-century advances in hygienic theory.6 In fact, the spa was to be built in Pozo Amargo at the end of the eighteenth century. Although it is a small spa, the construction project mirrored major action plans for old Spanish spas, such as Trillo and Sacedón. Since ancient times, spas were considered to be “ideal cities,” and during the Enlightenment, attempts were made at updating them to a more urban model in order to promote bathers’ well-being. An interest in the landscapes and surrounding environments of spas gave way to a complementary therapy of curative water treatments. The use of these facilities by the bourgeoisie and aristocracy also necessitated greater care of urban, architectural and planning projects for public spaces, which occurred mostly in the nineteenth century. Specific facilities were built (fountains, parks, music stands, casinos, etc.), the quantity and quality of which depended on the spa’s category (Leboreiro, 1994: 101-163). Pozo Amargo came to life during the restoration of the monarchy – the golden age of Spanish spas (Reina, 1993: 28-29). Our work is intended to emphasise the important sociocultural heritage of these thermal facilities, as well as the energising power of their surrounding rural environments (Molina, 2004). In the case of Pozo Amargo, this means making the most of the underused curative mineral water resources, recovering and protecting the thermal town’s urban area and resolving some of the serious problems this site currently faces: a degraded environment with dwindling vegetation along the riverbanks, deteriorating plains landscapes due to the expansion of olive tree and cereal crops, a cultural and archaeological heritage that is barely valued or known, impoverished fauna as a result of agricultural pressures, lack of treatment for sewage spillovers, and Among the abundant literature on this topic, the following quality texts are noteworthy: Alonso et al., 2011, Larrinaga, 2010 and RodríguezSánchez, 1994.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.3.

so forth (Programa, 1999). Undertaking a landscape rehabilitation project in the near future to protect the curative mineral waters and surrounding area, as well as reopening the thermal facilities would undoubtedly help preserve the rich heritage of the upper Guadaíra river basin and create an interesting environmental and landscape recovery experiment in terms of water, health, landscape and leisure (Larrubia and Luque, 2002).

3. Definition of the Territorial Area of the Guadaíra River Basin 132 The hydrographic basin of the Guadaíra River is small in size, demarcated by the Guadalquivir depression and another geomorphological unit: the Subbéticas. It covers approximately 1,305 km2 distributed throughout 15 municipalities, and inhabited by over 350,000 people. It is mainly a Sevillian basin, although, paradoxically, the old Pozo Amargo spa is located in the municipality of Puerto Serrano in Cadiz (Reina, 1993: 34-39). The basin is located at a low altitude, even at the river’s head, since the source of the Guadaíra River is only 360 metres above sea level in the Serrano foothills. This circumstance, along with the proximity of the Guadalquivir Valley, explains the river’s short length – only 130 km – which is not regulated in any way.7 We must mention the elevated contamination rate in the river basin’s water due to industrial, urban and agricultural waste dumping, especially from the olive agricultural transformation industry. In addition to these water contamination problems, there has been significant forest degradation, which is clearly visible in the basin’s riverbanks, plains and countryside. Far from causing the local population to distance themselves sentimentally from their environment, this situation has facilitated a strong movement, thanks to which the Administration of the Autonomous Government of Andalusia has been pressured to face the basin’s serious situation. Despite its degradation, the river is still seen not only as an outstanding part of the natural heritage that should be protected, but also as the primary reason for the rich historical and cultural heritage: the Guadaíra is therefore a highly transcendent territorial element. The waterwheels that used to grind the wheat from the fields near the riverbanks are closely related to the importance of towns such as Alcalá in supplying resources for the city of Seville. The olive and cereal farmlands (Krumrain, 2001) brought about the construction of country houses and estates throughout the basin, supplying raw materials to the entire metropolitan area and incidentally increasing the rich architectural heritage. However, the river’s significance has not been solely economic or related to its heritage (Bernal, 2003; Campos, 2005; Hidalgo and Fernández, 2006; Pozo, 2000 and 2002). Prior to its deterioration, the Guadaíra River was enjoyed for its riverbanks, parks and gardens, a recreational, festive and cultural phenomenon encouraged and promoted first by the Exposition of 1929, and later by the arrival of the railroad in Alcalá (Fernández, 2002; García Rivero, 2006). Our focus will allow us to integrate the physical, human and cultural aspects of the basin, as well as the water cycle in a framework that gives each component meaning. In this way, we can discuss the basin’s identity in contrast to the administrative reality, enabling us to connect two very different environments: the Guadalquivir Valley on the one hand, and the Subbetic system on the other. This connection between extremely diverse geological realities explains everything from the very upwelling of the water to the historical, cultural and economic characteristics of this area. Both the hydrographic basin and the water cycle can enable our understanding of many of the paradoxes hidden within the context of the spa – paradoxes that shocked us Nevertheless, an important project was completed at the end of the river, which consisted of diverting its original course to avoid flooding in the city of Seville (Del Moral Ituarte, 1991).

3.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

133

when we first visited the Guadaíra river basin. We found ourselves in a historically contaminated basin which nevertheless has a curative mineral water spring in Pozo Amargo. This is the first paradox. The town of Pozo Amargo, which barely has a stable population, is the only town that is supplied with water from the basin; the rest of the area’s towns have resorted to water from other basins due to the poor management of their own groundwater and underground water. At some point in history, the water from the Guadaíra, which supplied the Sevillian capital with high-quality water, started to be used as the natural drainage for the olive packaging industry throughout the entire basin (Morón and Alcalá de Guadaíra, for example) (Del Moral Ituarte, 2002). This is the second paradox. Pozo Amargo, with its curative mineral water spring, is the only town that does not treat its sewage either theoretically or practically,8 which is the third paradox. It is also extremely telling that the upper Guadaíra, the basin territory with the greatest environmental and landscape value in terms of amassing potential heritage, has been forgotten in the Guadaíra white and green plans (GAIA, 1998). This is the fourth paradox. Lastly, with serious repercussions for the enclave of Pozo Amargo, the abrupt administrative separation of this part of the province of Seville to the Puerto Serrano district in Cadiz has caused significant interference in the identity of the Guadaíra upper river basin.

4. Hydrological Characterisation of the Basin The Guadaíra river basin provides an important connection between the Guadalquivir Valley, the Baetic system and the Atlantic basin, circumstances that make the mouth of the river where the Pozo Amargo spa and town are located more valuable (Asociación Gaya, 1996; López, 1997; Rubiales, 2000). This connection to the Atlantic has historically linked this area with the smuggling phenomenon as well as the Andalusian Carlism movement. The Guadaíra was also a clear corridor for the movement of people and goods to Seville, the capital of the Guadalquivir Valley, which explains the toponym “supply river.” This connection between the Guadalquivir Valley and mountain range and the Atlantic basin favours transit, as well as the historical-cultural heritage and, in many cases, conflicts.9 The current of human use has always favoured the lower river basin, which coincides with the metropolitan area of Seville, but the project in Pozo Amargo is intended to change this trend and to guarantee a better future for the region. The basin is rich in aquifers, although they are currently underused. The Pozo Amargo aquifer is the least relevant from a quantitative perspective, although it is significant from a qualitative perspective due to the Pozo Amargo spring. It has always supplied the spa and town that grew up alongside it. It is currently the only inhabited enclave that is supplied with water from the Guadaíra river basin, despite the important aquifers located there.10

The Pozo Amargo treatment plant was included in the plan called “Guadaíra Blanco,” but it was never built. Recall, for example, the story of all the conflicts linked to the Moorish neighbourhood gang, and see the references to this in Carmona, 2000, Morilla, 1996 and González Jiménez, 1996. 10 The towns in the river basin receive their water supply from Emasesa, Aguas del Huesna and the Écija Plan Consortium; in other words, they have three different managers and are supplied by resources outside the basin in all three cases. 8

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.3.

5. Diagnosis Since the Guadaíra river basin is an ancient marine gulf with colmated limestone and calcarenite sediment, which have given way to landscape landmarks such as the Alcores and the Esparteros mountain ranges, the region’s geomorphology has been influenced by this fact and the evident effects of water, which has not only intervened in modelling the relief, but also the formation of many aquifers. These aquifers are currently recovering since high-quality water for human use is supplied from other basins, as we have already mentioned. Therefore, the conservation of the Pozo Amargo spring has necessarily become a general policy to preserve other underground water reserves as well and avoid contamination at all costs. The Pozo Amargo aquifer, in contrast to the rest of the basin’s aquifers, is not located in the most populated area and, therefore, it is unlikely that it will be subject to pressure and overexploitation, although it could be affected by sewage contamination from the town and agricultural use of the land. Our interest in preserving Pozo Amargo’s underground water – and in general in the entire basin – has a raison d’etre: the conservation of underground water has been neglected in previous projects carried out in the Guadaíra, which have instead focussed on the chemical quality of the groundwater. The fact that Pozo Amargo is not near any large cities or highly frequented transportation routes has served in its favour, as has the fact that the town’s houses continue to be used both as primary and secondary homes. Incidentally, we can affirm that the rich heritage conserved in the Guadaíra is precisely due to the fact that the upper river course is the only section that maintains its potential uses in the case of both the spa and the nearby traditional salt mines, which are still in use. This gives us great hope that we will achieve the conservation of these rich examples of historical and ethnographic heritage. From a historical perspective, the transfer of the town of Pozo Amargo to the province of Cadiz does not seem to have been a good political move since it involved breaking the long tradition that connected this area to Seville, contributing even more (if possible) to Pozo Amargo residents’ feeling abandoned by the local and provincial administration.11 This fact, however, has promoted an associative movement among the town’s homeowners, who are united by the feeling of residing in a place with a very special heritage. The recovery of the spa and the surrounding landscape would allow the positive qualities of the Guadaíra upper river basin to be disseminated to the public, facilitating access and introducing people to the mouth of the Guadalete via the road that connects Morón and Coripe. It would bring back a recreational and health-related facet to the upper Guadaíra, which it already possessed at the beginning of the twentieth century, as quite a few citizens of Sevilla travelled by train to Alcalá on the weekends for “fun”. Landscape projects conducted in the spa’s surroundings are intended to alleviate the homogenisation and impoverishment of the water-related ecosystems throughout the Guadaíra river basin due to human-related pressures. The recovery of forests on the riverbanks and shores, rocky terrain, Mediterranean scrublands, and oak and cork oak groves will provide added value to the environment of Pozo Amargo. Expansion of the endemic species must be accompanied by a strict control of invasive and ornamental species and reedbeds, as well as the recovery of populations of amphibians, reptiles, riverbed birds, steppe birds (Montagu’s Harrier, Bonelli’s Eagle, etc.), mammals (fallow deer, foxes, and small-spotted genets) and fish (eels, barbells, etc.) (Programa, 2006). The administrative problem that led to Pozo Amargo’s dependency on the province of Cadiz can only be resolved through honest, open collaboration between two municipalities (Morón and Puerto Serrano), which must come to an understanding in an effort to offer the upper Guadaíra the possibility of finding and dignifying itself. Prior to Pozo Amargo’s separation from Morón, Puerto Serrano was separated from the Sevillian city (1835) (Del Arco and Chezo, 2004; Pascual, 1996). 11

134

3.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

6. Project Site: Pozo Amargo Town and Spa (Puerto Serrano, Cadiz)

135

The proposed project site is located in the upper Guadaíra, corresponding to the landscape region pertaining to the Subbetic foothills and the Morón mountain range. As we have already mentioned, this area is rich in aquifers and noteworthy for its proximity to the Pozo Amargo aquifer, which has its own spring, and the Montellano aquifer. The town and old spa can be accessed from Seville-Morón via the A8126 roadway, catalogued as an official roadway of scenic interest (Morón-Algodonales) (Guía, 2008) and located only 15 km from Morón de la Frontera. It is an isolated population centre that was formed to house bathers at the nearby spa. When the spa was closed down, the town’s houses were sold to individuals, who currently tend to use them as secondary homes (Reina, 1994: 39-42). The history of this village brings us closer to another aspect that is closely linked to thermalism: namely, the importance of the curative mineral water springs which explains the origin of these towns as described by Pliny the Elder and Seneca: Alhama de Granada, Alhama de Almería, Alhama de Murcia, Alhama de Aragón, Caldas de Malavella, Caldas de Montbui, Baños de Montemayor, Ourense, and so on,12 all of which have linked their urban origins with the existence of curative mineral waters. The town’s surroundings include mountainous areas and Mediterranean scrublands (the Pozo Amargo mountain range and other small adjoining mountain ranges), as well as agrosystems with plains, cereal and olive fields, and extensive animal farms. Therefore, there is an interesting mix of ecosystems that contribute great landscape and natural value to the area. This means that there is a strong potential for increasing the sensorial enjoyment of the landscape, which is one of the purposes of the Pozo Amargo project.13 Sensorial enjoyment is intended to improve the well-being of tourists and residents, and increasing it means improving the landscape features of the thermal town as well. For this project, we would employ a series of potential sensorial possibilities in the rural area. In 1840 Pascual Madoz said of Pozo Amargo that “the temperature is very pleasant, mainly in the spring and summertime, and the dry, cool, light breeze is renewed and charged with aromatic scents from the abundant vegetation in the area” (cited in Reina, 1993: 14). Going for a walk, one of the primary activities traditionally linked with spas, allows visitors to enjoy the environment with all of their senses – sight, smell, sound, and so forth – which are heightened by this activity, with the silence of the night often the most gratifying. This is one of the reasons why environmental and landscape projects should reinforce the use of indigenous plants with intense aromas, such as thyme, lavender, basil, rockrose and wild roses,14 in garden areas as well as areas of recovered Mediterranean forest (Díaz, 1998). Regional ornamental plants such as jasmine and night blooming jasmine that give off exquisite, fragrant fruit aromas including citrus and fig could be used in the garden areas, and so could riverbank trees such as poplars and black poplars, which fulfill the evident, unmistakable landscape purpose of marking the curves of the river, in addition to their environmental function.15

These establishments are not at all related to the famous thermal spas of Caracalla and Diocleciano, since the water from these is not curative mineral water; Spas are not considered to be a “modern invention” since they already existed in ancient Rome. 13 Here we should mention the problems derived from not treating the sewage in Pozo Amargo and the contamination from nearby crops. 14 Martín (1993: 55) recreates a nighttime walk full of sensations in the spa’s surroundings: “no noises were heard in the surroundings. Clean, soft gusts of wind blew by, a slight aroma of cinnamon, bread with sugar; there must have been a heliotrope bush nearby.” 15 One cannot help but recall those marvelous descriptions in Jean Giono’s book entitled The Man Who Planted Trees: “but upon returning, passing by the country house, I saw water flowing through the streambeds, which had been dry since time immemorial…. The wind dispersed certain seeds. As the water reappeared, willows, osiers, fields, gardens, flowers and a reason to live reemerged.” (I used the CD with music by the Paul Winter Consort and narration by Lara López, translated by Eloy Fuente, Sonifolk S.A., 1993). Some of these measures must be accompanied by others to restrict bad odours from facilities – garbage, fertiliser, treatment plants, and so on – making a wind study a priority in establishing landscape quality protocols. 12

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.3.

All these efforts would recover the environmental quality of the thermal surroundings and improve the quality of the landscape, with the potential for helping people recover by walking or bathing in the area.16 Madoz also pointed out that these qualities were already present in Pozo Amargo: “there are two valleys on the eastern and western sides of the mountain range that form large plains with a few country houses, ideal for a walk” (Reina, 1993: 14). The extensive introduction of cattle and amphibian breeding in the spa surroundings has increased the pleasant sounds that abate the bothersome noises of the health and well-being tourist destination. Such sounds can also serve as a successful mechanism, which is discernible to some degree in the descriptions of Azorín, and they must have been very common for the spa facilities of the nineteenth century and early twentieth century, characterised as they were during that time period in Spain by more vivid rural areas than today due to the better state of the rivers and wetlands: “the countryside is silent, black; you can hear the crystal clear sounds of toads” (1929: 134). The proximity of the Guadaíra River to the spa provides playful sounds, as described in El Correo de Cantabria on 14 August 1889, which alludes to the landscape and restorative values of the Pas River: “the location of the Viesgo Bridge is extremely pleasant, offering tranquility of the soul, combined with the river water’s peaceful current” (cited in San Pedro Martínez, 1993: 146). The whispering leaves, the river water and fountains, and the opportunities to observe, according to the theory of attention-related restoration, allow for reflection and concentration, decreasing stress. All of these are well-known tools for experienced bathers: “everything breathes peace and meditation and the constant murmur of the river invites you to think about the permanency of time as a constant present of eternity, calming the nerves of ambitious people, dissipating their worries and inviting impatient people to rest.”17 The rich chromatic tonalities of the earth in the upper Guadaíra, reinforced by the white of the limestone in the agricultural and thermal facilities; the green tones of the recovered indigenous vegetation, vegetable gardens and crop areas; the greys of the Pozo Amargo mountain range; and the blue sheets of water surging from the new thermal facilities all contribute to a chromatic improvement of the area’s beauty and its ability to transmit well-being. However, this ability is due not only to the variety of colours, but also to the variety of shapes and cultural determining factors or models in a landscape such as that of Pozo Amargo, which can be clearly identified with the European agropastoral model that has historically developed with the passage of time (Luginbühl, 2008). The upper Guadaíra area also has significant historical value, given the nature of its role as a border area, which was more relevant during the Reconquest (Moorish group), the Carlist wars and the nineteenth-century period of bandits and smugglers. The archaeological value is also abundant and noteworthy,18 although it has not been studied very much to date. The cultural, ethnographic and architectural heritage19 are also noteworthy due to the proximity of the spa town’s salt mines, which are still in use, and the many rural buildings that appropriately form part of the landscape environment. The recovery of all this local and regional identity is an inevitable element in a project like this, which is intended to improve the quality of life for inhabitants of Pozo Walking has not changed much since the nineteenth century and if we look at certain luxury thermal facility websites today, such as Villa Padierna-Thermas de Carratraca, we may be surprised to see that eight of the nine activities proposed by the clients of a spa of this calibre are related to walks. 17 Words of the marquis of Myra de Lyria in the prologue of Albano, 1979. 18 A great example of a thermal town with archaeological sites in the vicinity is Puente Viesgo in Cantabria where the Monte Castillo caves are located. These sites were a complementary resource to spa activities, especially since the 1940s. 19 “Estudios,” 1996, Giles et al., 1999 and Ruiz and Gutiérrez, 1997. In particular, one should read the Mauror monograph dedicated to these topics (vol. 16, 2006), which contains interesting articles on the cultural heritage of the environment of Morón, including the urban landscape and heritage, rural architecture, limestone quarries, and so on. 16

136

3.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Amargo and users of the spa, and recover meaning for the public good. A place like Pozo Amargo is far from being a homogenising space; it is rooted in the land and favours people’s love and affection for the area due to its strong personality.

137

Consequently, the project will be developed in a series of phases: 1) the conservation of the spring’s water quality and its environment, 2) the cultural heritage associated with the spa and town, 3) the natural environment included in the protected area and the visible basin, and 4) the historical and archaeological heritage. It also includes the development of public projects, the promotion of social participation,20 the reactivation of artisan industries, a plan for disseminating and monitoring the projects and, lastly, the development of supramunicipal and municipal regulations to control problems derived from the currently weak institutional relationships with Puerto Serrano.21 This Pozo Amargo project is explained and justified by the neglect of the upper Guadaíra in previous river projects, a circumstance which can be explained by the low urban pressures in the area, as well as the high quality of the groundwater and aquifers.22 Within the general context of a highly contaminated river basin, this all becomes more relevant due to the curative mineral water springs, which require protection to prevent their deterioration or potential disappearance. The Pozo Amargo landscape and environmental project would resolve the sewage problem for which this area is currently known and would initiate a debate regarding the possibilities for greater human use of the basin’s underground water, which necessitates greater attention to quality. The project has interesting landscape potential, mitigating the serious erosion of the hills due to clearings caused by the improper farming of olive and cereal crops. This would improve the views of the spa environment so that everything would benefit from the improvements to the spa facilities, thereby reinforcing the supply of thermal installations opened to the public in western Andalusia, which barely exists today. We are sure that prior projects in the Guadaíra (including the Coordinated Comprehensive Programme for Cleaning and Recovery of the Guadaíra River in 1996, also known as Green Guadaíra) have permitted the recovery of the rich hydrological heritage (natural, historical and cultural) of the flour mills of Alcalá, enriching the basin’s hydraulic landscape, but it is also very evident that the recovery of traditional activities still has not been proposed or specified, although these activities would not only enrich the basin’s landscape but also reinforce the economic viability of Pozo Amargo’s environment as represented by the spa facilities and salt mines we have already mentioned in this paper.23 Incidentally, the recovery of the Pozo Amargo town and spa, protection of the rural architecture and land planning and landscape management of its surroundings would diversify the region’s economy, reactivating it on the basis of environmental recovery, while emphasising the historical role of this area bordering between the Guadalquivir and Guadalete valleys.24 Despite the difficulties involved in breaking the regional administration’s tendency to ignore the environmental, cultural and socioeconomic Today landscape projects increasingly rely on social participation. These participatory projects contrast with the former urban utopia of the enlightened elite, who saw the need to rehabilitate Spanish spas, although the country’s economy could not afford major advances in this area. Nevertheless, during the Enlightenment, some of the land was prepared for future rehabilitation at spas such as Trillo, Archena, Caldas de Besaya, Solán de Cabras, La Isabela, and Caldas de Oviedo, and renowned architects such as Ventura Rodríguez, López Aguado and Mas i Font were already working on them. However, many current projects still lack a connection with the culture of the land where they are located, creating a disconnection between thermal towns and their thermal resources, as in the case of Carratraca, Malaga. Sustainable projects unquestionably lead us to a participatory model. 21 This has already facilitated the appearance of certain urban excesses in the town, which have altered its original structure and urban features. 22 The region has underground water originating from the Pozo Amargo aquifer, which currently supplies the town. Furthermore, the curative mineral water springs have a flow volume of 8,000 litres/hour, which can be employed for other uses as necessary. 23 Traditional limestone fabrication, which is currently carving out a niche in the artisan market for this product, should be added to these activities. This could play a key role as a quality artisan product for the recovery process of these facilities (Carrillo, 2005). 24 This border position favoured the exchange of raw materials between both regions, although the attraction of Seville, the large commercial city of the Guadalquivir Valley, made trade much easier (Rodríguez, 1998). 20

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.3.

problems of the upper Guadaíra, and the difficulties involved in initiating a thermal project25 due to the different criteria for public health, heritage and the like in various national, regional and local regulations, we intend to recover the thermal village. This project is similar to what is occurring in the Galician city of Ourense,26 which came about due to the As Burgas springs dating back to pre-Roman times, a thermal tradition which the city has recently decided to incorporate as one of its defining elements. Similarly, the English city of Bath decided some years earlier to associate itself with the European thermal tradition, although the city did not have any spas in use until the execution of this project. Their recovery was significant, as the city discovered its essence in the spa, which, as we know, is a determining factor in its unique personality. Can we include Pozo Amargo in this long tradition that connects the Guadaíra to the city of Seville? We think so, and plan to incorporate the village’s treatment of the landscape and environmental recovery of its surroundings, in addition to other criteria that are currently essential for this type of facility: professionalisation, training, and the introduction of quality criteria,27 personalised criteria and innovation in modern, well-organised and managed facilities that promote the natural richness of the curative mineral waters and the landscape. This would provide the region with the possibility of tourism development accompanied by environmental, landscape, historical-artistic and ethnographic management. Sustainability certifications should be obtained, including Carbon Neutrality, Tourism Sustainability, Luxury Eco Certification Standards and the Green World Award. Given the complexity of a project of this kind, it is clear that institutional involvement and support are necessary, but there should also be space for the private initiative since the thermal facilities are viable in and of themselves. The Council of Ministers’ approval of the 2010-2014 Sustainable Rural Development Programme on 4 June 2010 permitted the inclusion of spas in this programme.28 This circumstance opens up an interesting path for financing all projects related to quality, protection and added value for mineral water resources and their integration in the natural and landscape environment, as well as the business and social framework of each region. This is why a proposal such as ours fits into the Rural Area Plan that is currently being prepared: it establishes the idea that thermalism could be a strategic industry for sustainable regional development of rural areas with thermal resources, and that the landscape perspective could contribute numerous improvements to the specific project described herein. Our holistic project makes a lot of sense at a time when the thermal industry is surpassing the traditional concept of spas as simple health centres. Today, spas are open – although to a certain degree they always were – to different products. This influences the landscape and environmental quality, which is why an intervention project at Pozo Amargo and the recovery of the area’s historical and archaeological heritage makes so much sense: as the cultural, educational and economic level of spa users increases, they are more prepared to appreciate this kind of effort. . The well-conserved areas of the spa’s environment and areas included in the project, such as the river and cereal crop areas that have eaten away at the Mediterranean mountain land, must permit the recovery In his speech at the International Thermal Tourism Conference in Ourense, 2-6 March 2011, Miguel Mirones, who is currently the President of the National Spa Association (ANBAL), emphasised the need for regulations to extend across the board. 26 Discussed in the speeches by Francisco Rodríguez Fernández, Mayor of the Ourense City Council, and José Luis Baltar Pumar, President of the Provincial Council of Ourense, at the International Thermal Tourism Conference in Ourense, 2-6 March 2011. 27 Incorporating this thermal experience in the upper Guadaíra could be a pioneering effort which would require introducing landscape criteria in international quality standards for thermal and therapeutic facilities such as Calidad Turística Española (Q), Organización Internacional para la Estandarización (ISO), Certificado de Calidad de la Asociación de Balnearios de Europa (EUROPESPA). 28 See the declarations of the Thermalism Observatory for the preliminary version of the Sustainable Rural Development Programme, which includes Thermalism and Thermal Tourism. These statements were made in Alhama, Granada, on 4 December 2009. They emphasise the sustainability of thermal resources and the possibility of job creation in the rural environment. 25

138

3.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

of indigenous vegetation and traditional vegetable garden areas that not too long ago surrounded the thermal establishment. The possibility for users to get involved in this environmental recovery plan gives it more meaning at a time when an increasing percentage of the users of this type of facility wishes to participate in active recreational activities that allow them to be a part of the environment and, to a certain degree, create a landscape in which they feel implicated.

139

Final Reflections We will finish as we started by discussing the beauty of Pozo Amargo’s landscape. We believe in it and we are also aware of the possible negative repercussions of a project that is not respectful of this environment. This is why it is necessary to recover the microhistories hidden in the village, recalling the anonymous creators of Pozo Amargo’s landscape, and abating its processes and phases of decadence so as not to succumb to proposals that stray from its historical roots. We must learn how these creators instilled the emotional roots of their people in these houses, the thermal village square and the small church; how they instilled a feeling of belonging and how this feeling has evolved over time. We can still find remnants of what once was in Pozo Amargo, and we can see ourselves in it. All these reasons explain our need to recover the spa and Pozo Amargo’s purpose as a town – its raison d’etre. This is a process of searching for the town’s identity, as recently occurred in Bath and so many other thermal towns wishing to recover their personality. This sustainability-based dignifying project for Pozo Amargo is the basis of our proposal for recovering the feeling of belonging in this corner of the upper Guadaíra, and relying on the basin’s very active associations. If we are able to repair these landscapes sentimentally, a part of our journey will be complete. If we are able to achieve the visual quality of definitive beauty, viewed not just as an unimportant accessory but rather as an essential value for humanity’s relationship with the landscape, we will have taken a major step forward.29

How could we not recall Akira Kurosawa’s wonderful scene in the full-length film “Dreams” in which the spirits of peaches reproach the son of a family that cut them down. He cries in their absence, but claims that he is not crying because he liked the peaches and can no longer eat them, since peaches can always be bought, but rather because the beauty of the full peach orchard in bloom can never be bought (Kurosowa, 1990). This episode exemplifies as few do, both visually and musically, how a landscape trauma can become a psychological trauma, how depression triggered by a landscape trauma can increase human psychological vulnerability, and how important the landscape’s beauty is to what we call “quality of life” (Vallerani, 2008: 75). Or, as the old man says in the dream “Village of the Waterwheels,” “the most important things for human beings are clean air and water, and the trees and herbs they produce” (Kurosowa, 1990). 29

3.3.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

References Albano, A., 1979, Caldas de Bohí. Anécdotas de mi vida balnearia, 2nd edition, Farrús Folguera Industrias Gráficas, Sabadell. Alonso, L., Lindoso, E., Vilar, M., 2011, O lecer das augas. Historia dos balnearios de Galicia (1700-1936), Editorial Galaxia, Vigo. Asociación Gaya, 1996, Inventario del paisaje natural del agua en Morón. I. El Alto de Guadaíra o río Esparteros (El arroyo del Fontanar y los embalses de Mancera y el Fontanar), Mauror, Morón de la Frontera, vol. 2, 89-127. Azorín, 1929, Veraneo sentimental, Librería General, Zaragoza. Bedell, R., 2010, ‘La naturaleza es un gran remedio’: Durand y el paisaje terapéutico, in Fundación Juan March and New York Historical Society, Los paisajes Americanos de Asher B. Durand (1796-1886), Madrid. Bernal, A. M. (dir.), 2003, Estudio de la industria panadera de Alcalá de Guadaira, Ayuntamiento de Alcalá de Guadaira, Alcalá de Guadaíra. Calavia Santos, L., 1918, Joyas de Aragón. Reseñas históricas de Jaraba, de sus afamados baños y de su milagrosa Virgen, Guillén y Romero, Calatayud. Campos, M., 2005, El pan de Alcalá, Ayuntamiento de Alcalá de Guadaira, Alcalá de Guadaíra. Carmona, A., 2000, El aprovechamiento de la Algaida de Cote (Bosque de San Pablo, Montellano), siglos XIII-XVI, Mauror, Morón de la Frontera, vol. 9, 3-17. Carrillo, A., 2005, La cal de Morón, Asociación Cultural Hornos de la Cal de Morón, Sevilla. [S.n.], 2008, La contaminación de la industria de la aceituna de mesa de Morón de la Frontera, Centro de Estudios Caleros, Morón de la Frontera. Del Arco, S., Chezo, D., 2004, Puerto Serrano entre el acta fundacional de 1820 y la exposición de 1887, Mauror, Morón de la Frontera, vol. 13, 173-177. Del Moral Ituarte, L., 1991, La obra hidráulica en la cuenca baja del Guadalquivir (siglos XVIII-XX). Gestión del agua y organización del territorio, Universidad de Sevilla, Consejería de Obras Públicas y Transportes and Ministerio de Agricultura, Pesca y Alimentación, Sevilla. Del Moral Ituarte, L. (coord.), 2002, El sistema de abastecimiento de agua de Sevilla: análisis de situación y alternativas al embalse de Melonares, Nueva cultura del agua, serie informes, no. 5, Bakeaz, Bilboa. Díaz, M., 1998, Paseo botánico por la vía verde de la sierra, Mauror, Morón de la Frontera, vol. 6, 121-128. Durand, A. B., 2010, Cartas sobre pintura de paisaje, 1855, Fundación Juan March, Madrid. [S.n.], 1996, Estudios geográficos históricos del antiguo territorio histórico moronés. Subprograma V. Inventario de los elementos culturales. Una aproximación al utillaje de los molinos del territorio antiguo moronés. Las culturas indígenas prerromanas y romanas I, Mauror, Morón de la Frontera, vol. 2, 143-152. Fernández, J., 2002, La escuela de Alcalá de Guadaira y el paisajismo sevillano, 1800-1936, Diputación de Sevilla and Ayuntamiento de Alcalá, Sevilla. GAIA, 1998, Salvemos el Guadaíra entre todos. Plan coordinado de recuperación del río Guadaíra, Mauror, Morón de la Frontera, vol. 5, 83-94. García Rivero, F., 2006, Crónicas y memorias de Alcalá de Guadaira, F. García, Alcalá de Guadaira. Giles, F., Santiago, A., Mata, E., Aguilera, l., Gutiérrez, M., 1999, El paleolítico de la cuenca media del Guadalete en el tramo Cádiz-Sevilla (Villamartín, Montellano y Puerto Serrano), Mauror, Morón de la Frontera, vol. 7, 55-69. González Jiménez, Manuel (Coord.), 1996, Actas de las II Jornadas de Temas Moronenses, 17-20 October 1994, Fundación Fernando Villalón and Departamento de Historia Medieval de la Universidad de Sevilla, Sevilla. [S.n.], 2008, Guía de carreteras Andalucía, Consejería de Obras Públicas y Vivienda, Junta de Andalucía, anejo número VIII, at: http://www. juntadeandalucia.es/viviendayordenaciondelterritorio/www/jsp/guia_carreteras/anejos.html (accessed 23 February 2011). Hidalgo, F., Fernández, M., 2006, El entorno rural y el patrimonio histórico en Alcalá de Guadaira, siglos XIII-XX, Ayuntamiento de Alcalá de Guadaira, Alcalá de Guadaíra. [S.n.], 2006, La industrialización medioambientalmente sostenible de la aceituna de mesa, I Jornadas Internacionales de la Aceituna de Mesa, Sevilla. Krumrain, G., 2001, El olivar en Morón: significación cultural, ecológica y económica, Mauror, Morón de la Frontera, vol. 10, 73-97. Kurosowa, A. (Director), 1990, El huerto de los duraznos, historia 2ª: “Akira Kurosawa’s dreams”, Japón (120min.), Distrib.: Warner Bros. Pictures Japón/EEUU. Larrinaga, C., 2010, Patrimonio del sector turístico: los balnearios. El caso guipuzcoano, areas, Revista internacional de Ciencias Sociales, vol. 29, 91-101. Larrubia, R., Luque, M., 2002, Las estaciones termales en Andalucía: de la explotación tradicional a la configuración de un nuevo producto turístico integral, Cuadernos de Turismo, vol. 10, 101-122. Leboreiro, A., 1994, El balneario: la ciudad ensimismada, Colegio Oficial de Arquitectos de Galicia, Vigo. López, J., 1997, Primera aproximación a la pardilla en los ríos de la Sierra Sur Baja de Sevilla, Mauror, Morón de la Frontera, vol. 4, 78-80. Luginbühl, Y., 2008, Paisatge i benestar individual i social, in Observatori del Paisatge-Generalitat de Catalunya, Paisatge i Salut, Barcelona-Olot. Malissard, A., 2001, Los romanos y el agua, Herder Editorial, Barcelona. Martín, C., 1993, El balneario, Alianza Editorial, Madrid. Molina, J., 2004, Termalismo y turismo en Catalunya: un estudio geohistórico contemporáneo, PhD thesis, Universidad de Barcelona. Morilla, P., 1996, Tres fronteras defensivas en el Morón del siglo XV, Mauror, Morón de la Frontera, vol. 1, 23-61. Moyano, E., Priego, C., 2009, Marco teórico para analizar las relaciones entre paisaje natural, salud y calidad de vida, Ponencia presentada a la mesa redonda Urbanismo, paisaje y salud pública, XIII Congreso de la Sociedad Española de Salud Pública y Administración Sanitaria, 3-6

140

3.3.

141

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

March, Sevilla. Ordóñez, J., [s.d.], El Guadaíra: un plan que nunca llega, in Confederación Hidrográfica del Guadalquivir and Ministerio de Medio Ambiente, La restauración de la Cuenca del Guadalquivir. Aportar ideas para construir realidades, Madrid. Pascual, J., 1996, Origen del nombre y población de Arahal, Mauror, Morón de la Frontera, vol. 1, p. 14. Pozo, F., 2000, Patrimonio histórico en el ámbito rural de la cuenca del río Guadaíra, Consejería de Obras Públicas y Transportes, Sevilla. Pozo, F., 2002, Los molinos harineros de la cuenca del río Guadaira, in Ministerio de Medio Ambiente and Confederación Hidrográfica del Guadalquivir Patrimonio histórico-hidráulico de la cuenca del Guadalquivir, Madrid. [S.n.], 1999, Programa coordinado de recuperación y mejora del río Guadaira, Consejería de Obras Públicas y Transportes, Junta de Andalucía, Sevilla. [S.n.], 2006, Programa coordinado para la recuperación y mejora del río Guadaira, Agencia Andaluza del Agua and Consejería de Medio Ambiente, at: http://www.rioguadaira.es/mapsite2/index.php?content=2# (accessed 23 February 2011). [S.n.], 2007, Programa coordinado para la recuperación y mejora del río Guadaira, at: http://www.rioguadaira.es/blogsite/calidad/calidad2.htm (accessed 23 February 2011). Reina, J., 1993, Balneario de Pozo Amargo (Documento I), Asociación Amigos de Morón, Morón de la Frontera. Reina, J., 1994, Balneario de Pozo Amargo (Documento II), Asociación Cultural Amigos de Morón and Asociación “Los Baños” de Pozo Amargo, Morón de la Frontera. Rodríguez, C., 1998, Piedras de Morón para la catedral de Sevilla, Mauror, Morón de la Frontera, vol. 5, 9-16. Rodríguez-Sánchez, A., 1994, Historia de los balnearios de la provincia de Málaga, Diputación Provincial de Málaga, Málaga. Rubiales, L., 2000, La nutria en el tramo alto del Guadaíra (Morón de la Frontera), Mauror, Morón de la Frontera, vol. 9, 161-169. Ruiz, A., Gutiérrez, M., 1997, Territorio y poblamiento protohistórico en la sierra de Pozo Amargo, Puerto Serrano, Cádiz, Mauror, Morón de la Frontera, vol. 4, 3-13. San Pedro Martínez, A., 1993, El balneario de Puente Viesgo, 1796-1936: el turismo balneario de interior en Cantabria. Génesis, esplendor y decadencia de un espacio de ocio, Universidad de Cantabria, Santander. Vallerani, F., 2008, La pèrdua traumàtica del sentit del lloc: degradació del paisatge i patologies depressives, in Observatori del Paisatge-Generalitat de Catalunya, Paisatge i Salut, Barcelona-Olot.

Author’s Contacts JESÚS RAÚL NAVARRO GARCÍA | jrauleeha@hotmail.com FREDERICO ALVIM | uenf.fred@gmail.com

Rural Well-Being Tourists: Online Information Search Behaviour

3.4. ANJA TUOHINO * JUHO PESONEN **

* Corresponding author. Development manager, UEF, Centre for Tourism Studies. ** Planner. University of Eastern Finland, Centre for Tourism Studies.

Go to Index

3.4.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Abstract Well-being tourism has become part of the Finnish tourism brand. Customers associate the brand with, for example, clean air, water, forests, tranquillity, and exercising in a naturally beautiful landscape and high-quality aesthetic environment. In 2008, the Finnish Tourist Board launched its well-being tourism strategy for the years 2009 to 2013. Rural areas represent typical tourism destinations in Finland, as well as in the context of Finnish well-being tourism. Hence, it is important to recognize who rural tourists are and examine their behaviour. Earlier research in Finland has already indicated that a segment of well-being tourists can be found among rural tourists. However, no research has been conducted regarding the marketing channels that rural well-being tourists use when they plan and book their holidays. For this reason, this paper examines how Finnish rural tourists interested in using well-being services during their holidays differ from other rural tourists when planning and booking holidays. In this paper, the main focus is especially on Internet marketing as this has become the most important distribution channel for many tourism companies. The quantitative data for this paper were gathered from the largest Finnish rural affiliate website during spring and summer 2011, consisting of 1515 responses. The results reveal significant differences between the information-seeking behaviour of rural well-being tourists and that of other rural tourists. The former are more active in seeking information and use blogs and other social media services more often than other tourists.

Keywords: online information, internet behaviour, rural well-being tourists, Finland.

144

3.4.

145

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

1. Introduction Well-being tourism has become part of the Finnish tourism brand. The Finnish Tourist Board (FTB) has recognized the importance of well-being tourism development in Finland and on the national level it has undertaken long-term and organized development efforts. In 2005, the first national review of well-being tourism was conducted (FTB, 2005). The review highlighted the growth potential of the well-being sector based upon the strong inherent assets of a safe, high-quality natural environment within which a wide range of outdoor activities are possible while still retaining the peace and tranquillity of the countryside and the culture of the sauna (FTB, 2005; Stevens, 2009). In 2007, a strategy work group for well-being tourism development was established and as a result the national Development Strategy for Finnish Well-Being Tourism in International Markets, 2009-2013 was launched in December 2008 (FTB, 2009). In the same year, the national review of well-being products was completed (FTB, 2008). In the strategy, the FTB defines three different kinds of well-being tourism goals, i.e. operational, image, and quantitative goals, for the period 2009-2013. The operational goals include among others the implementation of terminology and theme-based thinking in the field; networking and joint marketing; cooperation in distribution and pricing; year-round product offering and sales; identification and emulation of good operation models; and diversification and augmentation of the offering of accessible well-being tourism. The respective image goals are to develop a unified image for Finnish well-being tourism and for Finland to be known as a leading well-being tourism country in the Nordic region – to be achieved by creating an offering based on international trends and the increasing demand and by including well-being tourism as an integral part of the country brand through marketing communications. Finally, the quantitative goals include a growth target defined as +6% per year (overnight stays; Finnish Tourism Strategy 2006) and an increase in the international customer base for the companies participating in the product development process (FTB, 2009). At present, there are ongoing actions implementing the Finnish Wellbeing Strategy. One of the aims is to create standardized products for international wellness markets. One part of this process is a new brand called Finrelax® describing the basic offerings of Finnish well-being. In the strategy, the content of the basic offering includes issues like escaping from everyday routines, enjoying peace and nature, relaxing, and “recharging your batteries”. In addition, outdoor recreation, exploring nature, traditional Finnish forms of sauna bathing, a pleasant, aesthetically pleasing, and authentic environment, sauna, and traditional and well-known Finnish bathing customs and accommodation, e.g. holiday cottages, country hotels, B&Bs, farmhouse accommodation, or other similar tranquil environments, are given as examples of the subject matter (FTB, 2009). In Finland, countryside holidays in summer cottages or cabins can be deemed a good example of the Finrelax concept due to their closeness to nature in a very typical Finnish natural environment.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.4.

1.1. Conceptualization of Well-Being in Finland The conceptualization of well-being tourism in Finland, however, is fairly challenging. In the tourism context, there has been confusion about when to use the terms wellness and well-being. In the tourism field, there are also other concepts connected to the theme. For instance, concepts like health tourism and health-care tourism are used alongside well-being and wellness tourism (Konu et al., 2011). Health tourism refers to travelling away from home to take care of one’s health (García-Altés, 2005, 262; adapting Ross, 2001). Well-being and health-care tourism are acknowledged as sub-concepts of health tourism. Well-being tourism differs from health-care tourism regarding tourists’ motivations. The main motivation in well-being tourism is to prevent illness or maintain one’s health and well-being, whereas in health-care tourism it is to treat illness. Besides preventing illness and sustaining well-being, the goal of well-being tourism is to have experiences of pleasure and in a sense also luxury. Regarding tourism products and services, well-being tourism and health-care tourism are not very different from each other. To give an example, well-being tourists may use the same leisure or recreational services as health-care tourists and both tourism types may frequent the same destination simultaneously (FTB, 2005; Konu et al., 2010; Konu et al., 2011; Müller and Lanz Kaufmann, 2001; Suontausta and Tyni, 2005). Another issue is that the words wellness and well-being are rendered by one single word in Finnish; both English words are translated as ‘hyvinvointi’, which causes confusion and misuse. Wellness tourism is often connected to luxury products and five-star hotels, while well-being tourism may include products and services from a wider scale. It may include pampering, diverse activities, and experiences of luxury not necessarily connected to high-class hotels. This interpretation is supported by Yeoman (2008), who suggested that the future tourist is increasingly aware of luxury as a concept of fulfilment as opposed to materialism (see Konu et al., 2010). In Finnish well-being tourism, the most important motives for travelling are most likely to be connected to relaxation and physical activities. This is also the case when the product and service supply of Finnish well-being tourism companies is examined. Most of the products and services of spas, the various treatments and activities offered, are connected in one way or another to physical activity or relaxation. Thus, well-being tourism as a concept better reflects the supply of Finnish well-being because the supply concentrates mainly on sauna and active (well-being) or outdoor services. To summarize, in the Finnish context, the well-being tourism concept is more appropriate because the wider description better reflects the Finnish understanding of ‘hyvinvointi’ (Kangas and Tuohino, 2008; Konu et al., 2010; Konu et al., 2011). Against this background in Finland, both the role and the importance of well-being customers have now been accorded more importance, as a research area in customer research.

1.2. Rural Tourism as Part of Finnish Well-Being Tourism The built and natural physical environment of a destination can be considered as one of the core resources in tourism (Tuohino, 2006). While centuries ago tourism destinations developed around unique natural features, such as mineral healing waters, beach and mountain resorts, and sacred sites (Sheldon and Park, 2009), today most wellness or well-being tourism establishments are still located in a rural environment. To give examples, in the context of the Alpine wellness concept in Austria, Switzerland, and Germany, experiences of nature are an essential part of the well-being experience. A similar paradigm has been identified in Finland, while Konu et al. (2010) presented a concept of lake wellness, based on lakes. In Finland, well-being tourism often operates

146

3.4.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

in rural or natural environments, and in this sense it might be regarded as rural tourism. In Finland, the most common combination of rural tourism is a cottage or chalet by a lake.

147

The question is whether rural tourism can be regarded as a form of Finnish well-being tourism or whether a segment of rural well-being tourists can be found. Pesonen and Komppula (2010) pointed out through their Finnish case study that rural tourism can be classified as a type of well-being tourism and that a segment of rural well-being tourists can also be found. According to their findings, the main motivating factors for this group are relaxing away from the ordinary, escaping from a busy everyday life, a hassle-free vacation, being refreshed and having a sense of comfort, and an opportunity for physical rest. The motives represented a significantly higher value for rural well-being tourists than for the other segments. The profile of the segment showed that this group was quite homogenous in two aspects, namely 91% of the segment members were female and 85% had spent a remarkable part of their youth in a rural environment. Pesonen and Komppula (2010) argued that this segment may have a rural place identity, which refers to dimensions of self that define the individual’s personal identity in relation to a physical environment (Kulczycki and Lück, 2009). The case example of this paper is from domestic markets, despite the international focus of the well-being strategy. The reason for this is that currently, for the majority of Finnish tourism companies, domestic tourism is the most important source of revenue and especially important in off-peak seasons. This study can be regarded a priori as a segmentation study as the three segments formed by the respondents are decided by the researchers. In a priori or common-sense segmentation, the grouping criteria are known in advance. These criteria may, for example, be gender, age, and annual income. The other method is data-driven segmentation, in which the composition of segments is unknown in advance. Typically, the starting point in data-driven segmentation is an empirical data set that is analysed using quantitative techniques in order to derive a grouping (Dolnicar, 2002).

1.3. Information-Seeking Behaviour Information-seeking behaviour has been a popular topic in tourism research and information-seeking behaviour is often compared between different groups of tourists. Pearce and Schott (2005) examined international and domestic visitors’ use of a range of distribution channels to make travel, accommodation, and attraction arrangements at two New Zealand destinations. They found both similarities and differences between the two destinations and information-seeking, booking, and payment behaviour. Among other things, they found that domestic visitors use internal sources, such as word of mouth and previous experience, more than international visitors. According to Pearce and Schott (2005), the research on tourism distribution channels has been dominated by studies of providers and intermediaries. This study, like the study by Pearce and Schott (2005), extends the research on the topic of tourists’ information channel use. Grønflaten (2009) stated that knowing where and how travellers acquire information when planning their trip is essential for developing marketing strategies. Knowing how tourists interested in different kinds of well-being products search for information regarding their holiday is extremely important for companies offering well-being products and services or planning to develop them. This is something that has not been studied before. Regarding information-seeking behaviour, this study focuses on two “megatrends” of the Internet that can significantly impact on the tourism system: social media websites and searching as the dominant information-seeking mode in travellers’ use of the Internet (Xiang and Gretzel, 2010). The information-seeking pro-

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.4.

cess was revolutionized as a result of the Internet (Buhalis and Law, 2008). According to Fodness and Murray (1997), information technology reduces uncertainty and perceived risks as well as enhancing the quality of trips, as the more information found and more research undertaken on a trip, the better customersâ&#x20AC;&#x2122; needs can be met and served (Buhalis and Law, 2008). According to Snepenger et al. (1990), four major factors influence information seeking in the tourism context. These are the composition of vacation groups, the presence of families and friends at the destination, prior visits to the destination, and the degree of novelty associated with the destination. In this study, the main research question is how interest in well-being services affects the information-seeking behaviour of rural tourists. The structure of the paper is as follows. In Section Two, the methodology, questionnaire, and data are presented. Section Three presents the results and discusses the findings, and Section Four concludes the paper.

2. Methodology An online questionnaire was used to collect data for this study. The questionnaire was designed to measure respondentsâ&#x20AC;&#x2122; holiday information-seeking behaviour. The specific focus of the study is online information-seeking channels and social media. The survey questions were designed on the basis of the literature. The social media services used and the number of users using the service are listed and described in Table 1. The respondents were asked to tick all the social media services they had used during the past week before answering the questionnaire. The services measured were chosen according to their popularity in Finland and their relevance to tourism marketing. The information sources used when planning and booking a holiday were adapted from the studies by GrĂ¸nflaten (2009) and Pearce and Schott (2005). The different websites that respondents may use during their holiday information search process were adapted from a study by Jani et al. (2011). The respondents were asked to choose which well-being products and services they would be interested in using during their rural holiday. Thus, well-being tourists were defined as tourists interested in well-being products. The well-being services are listed in Table 1 with the number of interested respondents in each segment. Those interested in some well-being services are most likely to engage in different sports activities or visit a health spa during their holidays. Almost all rural tourists interested in many well-being services are interested in visiting health spas and in traditional health services.

Table 1 | Well-being Services and Interest in Using Them Interested in some (one or two) well-being services

Interested in many (at least three) well-being services

Participating in fitness and well-being seminars

2 (0.3%)

76 (16.6%)

Physical examination or fitness test

46 (5.9%)

121 (26.4%)

Visiting health spa (relaxation, special saunas, yoga, treatments etc.)

251 (32.1%)

402 (87.6%)

Traditional health services (e.g. facial treatments or pedicure)

147 (18.8%)

355 (77.3%)

Alternative treatments (e.g. reiki or shiatsu)

49 (6.3%)

232 (50.5%)

Various sports activities

348 (44.5%)

297 (64.7%)

Massage

190 (24.3%)

323 (70.4%)

148

3.4.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

149

A banner with a link to the questionnaire was posted on the website www.lomarengas.fi, which is the oldest, largest, and best-known intermediary organization for rural tourism services in Finland. The data for this study were collected between 8 March and 1 July 2011. The questionnaire was in Finnish. Altogether 1,515 eligible responses were collected during the study period. The data analysis was conducted in two parts. First, the respondents were divided into three groups according to how many different well-being services they were interested in during their holiday. The first group consists of respondents who were not interested in any well-being services (N=274). The second group includes those respondents who were interested in one or two well-being services (N=782). The third group includes those interested in many, at least three, different well-being services during their holiday (N=459). The information-seeking behaviour of these three groups was compared in the second stage using cross-tabulations and chi-square tests. ANOVA was used to compare the age differences between the groups. Only statistically significant differences are reported except for the most important information source.

3. Results and Discussion 3.1. Sample Profile and Social Media Services Female respondents (71.4%) were slightly overrepresented in the sample when compared with the gender of users estimated by the marketing manager of the banner website. It is unknown whether females plan their holidays more than men and thus visit the site more often or whether they are more interested in responding to questionnaires than males. The mean and median age among the respondents was 39 years, and 25% of the respondents were less than 28 years old. Using an online questionnaire to collect the data means that the respondents are young or middle-aged and there are not many respondents aged over 65. This should be kept in mind when interpreting the results. The grey market segment was not included in this study because the online data collection could be completely different regarding their information-seeking behaviour and interest in well-being services. Table 2 shows the use of social media services among the respondents. Facebook, YouTube, and Google Maps are the most common, while none of the respondents used the online virtual world Second Life. Among the least-used social media services were also TripAdvisor, MySpace, and Flickr.

3.4.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Table 2 | Social Media Services of the Study Social media service

Description (based on Wikipedia)

Users (N=1515)

Facebook

Social networking service

905 (59.7%)

Twitter

Social networking and microblogging

43 (2.8%)

Business-related social networking site

53 (3.5%)

Youtube

Video-sharing website

724 (47.8%)

TripAdvisor

Travel information website, user-generated content

44 (2.9%)

Irc-gallery

One of the largest social networking websites in Finland

50 (3.3%)

MySpace

Social networking website

23 (1.5%)

Flickr

Image and video hosting website and online community

26 (1.7%)

Google Maps

Web mapping service application

577 (38.1%)

Suomi24

One of the largest social networking websites in Finland

419 (27.7%)

Wikis

Websites that allow the creation and editing of interlinked web pages, e.g. Wikipedia.org

486 (32.3%)

Blogs

Online journal, private or public

245 (16.2%)

Second life

Online virtual world

0 (0.0%)

3.2. Information-Seeking Behaviour For all the respondents, the Internet is the most important information channel when planning a holiday or making reservations (Table 3). There are also some respondents for whom brochures, friends or relatives, or previous knowledge of the destination are the most important information source. However, there are no statistical differences regarding the most important information source between the three groups of this study. Table 3 | Most Important Information Source when Planning a Holiday and Making Reservations Not interested in well-being services

Interested in some (one or two) well-being services

Interested in many (at least three) well-being services

Most important information channel (x2=10.30, p=0.111) Internet

175 (78.1%)

523 (76.4%)

318 (78.5%)

Brochures

20 (8.9%)

58 (8.5%)

46 (11.4%)

Friends / relatives

15 (6.7%)

54 (7.9%)

28 (6.9%)

Previous knowledge of the destination

14 (6.3%)

50 (7.3%)

13 (3.2%)

There are some statistical differences between the different groups regarding the other information channels that they use besides the most important information source (Table 4). More than one-quarter (26.6%) of the respondents interested in many well-being services also use magazines to search for holiday information. Television is not an important information channel for any group, whereas for almost half (48.8%) of those interested in many well-being services brochures are very important. Travel agencies and friends or relatives are more important information sources for those interested in well-being services than for those not interested in well-being services.

150

3.4.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Table 4 | Other Information Channels Used

151

Not interested in Interested in some (one or well-being services two) well-being services

Interested in many (at least three) well-being services

Magazines (x2=16.0, p<0.001)

46 (16.8%)

140 (17.9%)

122 (26.6%)

Television (x2=6.2, p=0.044)

8 (2.9%)

37 (4.7%)

32 (7.0%)

Brochures (x2=13.3, p=0.001)

106 (38.7%)

303 (38.7%)

224 (48.8%)

Guidebooks (x2=10.7, p=0.005)

41 (15.0%)

127 (16.2%)

105 (22.9%)

Friends / relatives (x2=23.4, p<0.001)

82 (29.9%)

234 (29.9%)

196 (42.7%)

Travel agency / other expert (x2=33.1, p<0.001)

21 (7.7%)

72 (9.2%)

88 (19.2%)

Respondents interested in well-being services seem to use social media more than those not interested (Table 5). Those interested in some well-being services use wikis least often (28.9%), whereas those interested in many well-being services use blogs most often (22.2%). Facebook and Youtube are popular in all the groups, but the respondents not interested in well-being services use these least. Table 5 | Social Media Channels Used Not interested in well-being services

Interested in some (one or two) well-being services

Interested in many (at least three) well-being services

Facebook (x2=13.8, p=0.001)

142 (51.8%)

462 (59.1%)

301 (65.6%)

Youtube (x2=11.4, p=0.003)

119 (43.4%)

356 (45.5%)

249 (54.2%)

Suomi24 (x2=13.8, p=0.001)

53 (19.3%)

242 (30.9%)

124 (27.0%)

Wikis (x2=7.5, p=0.024)

97 (35.4%)

226 (28.9%)

163 (35.5%)

Blogs (x2=17.8, p<0.001)

36 (13.1%)

107 (13.7%)

102 (22.2%)

The respondents were also asked what kind of Internet sites they used when planning their holidays and making reservations (Table 6). Respondents interested in well-being services use different websites much more often than other respondents. For example, almost all (88.5%) of the respondents interested in at least three well-being services use search engines such as Google to look for information regarding their holiday, whereas only 72.5% of those not interested in well-being services use a search engine. Social media are used relatively little, as are websites of magazines and newspapers. Table 6 | Internet Sites Used to Plan and Book Holidays Not interested in well-being services

Interested in some (one or two) well-being services

Interested in many (at least three) well-being services

Affiliate website (x2=11.6, p<0.003)

159 (58.0%)

492 (62.9%)

321 (69.9%)

Travel agentsâ&#x20AC;&#x2122; websites (x2=22.9, p<0.001)

80 (29.2%)

273 (34.9%)

209 (45.5%)

Destination website (x2=10.5, p=0.005)

85 (31.0%)

248 (31.7%)

184 (40.1%)

Search engine (x2=30.7, p<0.001)

206 (75.2%)

597 (76.3%)

406 (88.5%)

Magazinesâ&#x20AC;&#x2122; and newspapersâ&#x20AC;&#x2122; websites (x2=16.0, p<0.001)

31 (11.3%)

92 (11.8%)

89 (19.4%)

Discussion boards / blogs (x2=12.7, p=0.002)

40 (14.6%)

124 (15.9%)

106 (23.1%)

Social media (x2=23.3, p<0.001)

27 (9.9%)

80 (10.2%)

88 (19.2%)

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

3.4.

Regarding socio-demographic factors, the groups differ only in age and gender (Table 7). Those interested in many well-being services are younger than other respondents, with a mean age of 36.8 years, and there are statistically significantly more females (85.4%). There are no significant differences in travel companions or annual household income. Table 7 | Socio-Demographics Not interested in well-being services

Interested in some (one or two) well-being services

Interested in many (at least three) well-being services

39.1 / 13.3

40.3 / 12.9

36.8 / 13.1

Male

99 (36.9%)

262 (33.9%)

66 (14.6%)

Female

169 (63.1%)

512 (66.1%)

387 (85.4%)

Mean age / std. deviation (F=9.748, p<0.001) Gender (X2=63.3, p<0.001)

4. Discussion The results of this study show that tourists who are interested in well-being products and services differ from those who are not interested in well-being services during their rural holiday. Those interested in many well-being services especially differ clearly from other rural tourists. This segment can be regarded as a kind of heavy user segment. Rural tourists interested in many well-being services are the most active in their search for information. Besides social media, they also use different websites, such as destination websites, travel agentsâ&#x20AC;&#x2122; websites, search engines, and blogs, more than those who are less or not at all interested in well-being services. They are also younger than the members of other segments and mostly female. Those rural tourists interested in only some well-being services are very similar to those not interested in any well-being services regarding their information-seeking behaviour and socio-demographic characteristics. For all the segments in this study, the Internet is the most important information source, but other sources, such as brochures and friends and relatives, are also significant, especially for those interested in many different well-being services. Most of the respondents are familiar with social media and especially Facebook, but they are still not often used to plan holidays and make reservations.

5. Conclusions The main aim of this paper was to examine how Finnish rural tourists interested in using well-being services on holiday differ from other rural tourists when they plan their holiday and make reservations. The main focus was on Internet marketing as this has become the most important distribution channel for many tourism companies. The quantitative data for this paper were gathered online from the largest Finnish rural affiliate website during spring and summer 2011, and consist of 1,515 responses representing rural tourists in Finland going online. The results show that there are significant differences between the information-seeking behaviour of rural

152

3.4.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

well-being tourists and that of other rural tourists. The more interested a person is in well-being services, the more he or she searches for information. Heavy users are more active in seeking information and use blogs and other social media services more often than other tourists. The results also revealed that travel behaviour influences information-seeking behaviour. This means that the type of holiday the tourists are interested in can affect their information-seeking behaviour. This conclusion would add a major influencing factor to the four factors presented by Snepenger et al. (1990), but requires further study.

153

In light of the results of this study, it can be argued that tourism companies offering well-being services should make sure that there is enough information available regarding the services they sell. Heavy users of well-being services are familiar with social media services such as Facebook and Youtube and these channels could be used efficiently to promote well-being services. Search engine optimization is essential, especially for rural well-being companies, as almost 90% of heavy users use search engines when planning their holidays and making reservations. Affiliate websites, travel agents’ websites, and destination websites are also effective ways to reach these heavy users. There are significantly more female respondents in the sample than male respondents. This is not surprising as earlier research has found that females have a dominant role in the early stages of the tourism decision-making process in the household (Mottiar and Quinn, 2004). It is unknown whether females plan their holidays more than men and thus visit the site more often or whether they are more interested in responding to questionnaires than males. The marketing manager of the website (Huttunen, 2011) estimated that there are more female than male users of the website from which the data were collected, but how many more remains unknown. Nevertheless, the data can be regarded as representative of Finnish rural tourists going online to seek information regarding their holidays. This research also demonstrated the need for further research. One interesting theme should be how the type of well-being service affects the distribution channels that people use. The segmentation method used in this study is very crude and using data-driven market segmentation based on preferences for different well-being services could produce more in-depth segments of well-being-oriented rural tourists. Other interesting aspects include the differences between Finnish respondents and international respondents. This study measured potential rural tourists’ interest in well-being services. Hence, the actual behaviour of rural tourists is still unknown. Knowing what tourists would like to do is important in developing products and services and could produce different results as their actual behaviour is restricted by constraints not measured in this study, such as the resources available to tourists.

References Buhalis, D., Law, R., 2008, Progress in information technology and tourism management: 20 years on and 10 years after the Internet - The state of etourism research, Tourism Management, Vol. 29(4), 609–623. Dolnicar, S., 2002, A review of data-driven market segmentation in tourism, Journal of Travel & Tourism Marketing, Vol. 12(1), 1-12. Fodness, D., Murray, B., 1997, Tourist information search, Annals of Tourism Research, Vol. 24(3), 503–523. FTB, 2005, Hyvinvointi- ja wellness – matkailun peruskartoitus [Mapping of Wellbeing and Wellness Tourism]. Matkailun edistämiskeskus, MEK A:144. Helsinki. FTB, 2008, Hyvinvointimatkailutuotteiden kartoitus 2007. MEK E:56. [http://www.mek.fi/W5/mekfi/index.nsf/6dbe7db571ccef1cc225678b004e73ed/3dc4bc5ed78eb257c225745d0038789c/$FILE/E56%20Hyvinvointituotteiden_kartoitus_2007.pdf] (site accessed 9 September 2011). FTB, 2009, Suomalaisen hyvinvointimatkailun kehittämisstrategia kansainvälisillä markkinoilla 2008-2013 [Development Strategy for Finnish Well-Being Tourism in International Markets 2009-2013]. [http://www.mek.fi/relis/REL_LIB.NSF/0/ab7bf278bfc033c0c225751d003149fc/$FILE/Hyvinvointimatkailun%20kehitt%C3%A4misstrategia_final.pdf] (site accessed 9 September 2011).

3.4.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

García-Altés, A., 2005, The development of health tourism services, Annals of Tourism Research, Vol. 32(1), 262–266. Grønflaten, Ø., 2009, The tourist information matrix – Differentiating between sources and channels in the assessment of travellers’ information search, Scandinavian Journal of Hospitality and Tourism, Vol. 9(1), 39-64. Huttunen, P., 2011, Personal interview on 13 September 2011. Jani, D., Jang, J.-H., & Hwang, Y.-H., 2011, Personality and tourists’ Internet behaviour, in Law, R., Fuchs, M., Ricci, F. (eds.), Information and Communication Technologies in Tourism 2011, Springer-Verlag, Wien, 587-598. Kangas, H., Tuohino, A., 2008, Lake wellness – Uusi itäsuomalainen innovaatio? Matkailututkimus, Vol. 4(1), 23–41. Konu, H., Tuohino, A., Björk, P., 2011, Wellbeing tourism in Finland: Finland as a competitive wellbeing tourism destination [http://epublications. uef.fi/pub/urn_isbn_978-952-61-0585-7/urn_isbn_978-952-61-0585-7.pdf] Konu, H., Tuohino, A., Komppula R., 2010, Lake wellness – A practical example of a new service development (NSD) concept in tourism industries, Journal of Vacation Marketing, Vol. 16(2), 125–139. Kulczycki, C., Lück, M., 2009, Outdoor adventure tourism, wellness and place attachment, in Bushell, R., Sheldon, P. J. (eds.), Wellness and Tourism. Mind, Body, Spirit, Place, Congniznat Communication, New York, 165-176. Mottiar, Z., Quinn, D., 2004, Couple dynamics in household tourism decision making: Women as the gatekeepers? Journal of Vacation Marketing, Vol. 10(2), 149–160. Müller, H., Lanz Kauffman, E., 2001, Wellness tourism: Market analysis of a special health tourism segment and implications for the hotel industry, Journal of Vacation Marketing, Vol. 7(1), 5–17. Pearce, D. G., Schott, C., 2005, Tourism distribution channels: The visitors’ perspective, Journal of Travel Research, Vol. 44(1), 50–63. Pesonen, J., Komppula, R., 2010, Rural wellbeing tourism: Motivations and expectations, Journal of Hospitality and Tourism Management, Vol. 17(1), 150-157. Ross, K., 2001, Hospitality Net - Industry News - Health Tourism: An Overview By Kim Ross (HSMAI Marketing Review) [http://www.hospitalitynet.org/news/4010521. search?query=%22health+tourism%22] (site accessed 27 December 2006). Sheldon, P. J., Park, S.-Y., 2009, Development of sustainable wellness destination, in Bushell, R., Sheldon, P. J. (eds.), Wellness and Tourism – Mind, Body, Spirit, Place, Cognizant Communication Corporation, New York, 99–113. Snepenger, D., Meged, K., Snelling, M., Worrall, K., 1990, Information search strategies by information-naive tourists, Journal of Travel Research, Vol. 29(1), 13–16. Stevens, T., 2009, Naturally Finland – Wellbeing and Health Tourism in Finland. [http://www.healthtourismmagazine.com/article/naturally-finland.html] (site accessed 15 May 2011). Suontausta, H., Tyni, M., 2005, Wellness-matkailu – hyvinvointi matkailun tuotekehityksessä, Edita Prima Oy, Helsinki. Tuohino, A., 2006, Lakes as an opportunity for tourism marketing: In search of the spirit of the lake, in Hall, C. M., Härkönen, T. (eds.), Lake Tourism. An Integrated Approach to Lacustrine Tourism Systems, Channel View Publications, Clevedon, 101–118. Xiang, Z., Gretzel, U., 2010, Role of social media in online travel information search, Tourism Management, Vol. 31(2), 179–188. Yeoman I., 2008, Tomorrow’s Tourist: Scenarios and Trends (Advances in Tourism Research Series), Elsevier, Oxford.

Author’s Contacts ANJA TUOHINO | anja.tuohino@uef.fi JUHO PESONEN | juho.pesonen@uef.fi

154

Conclusions

Go to Index

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Some Reflections on the Further Evolution of Sustainable Medical and Wellness Tourism Destinations Veronika Joukes

To close this series of case studies, we thought it might be enlightening to share some reflections about what will happen within the medical and wellness sector over the coming years, taking advantage of and bringing together the opinions and recommendations formulated in the previous chapters. We have streamlined our beliefs to privilege examples related to the Portuguese market, as we know that market best, and also because living globally permits the exportation of good practice elements to either side of the world, where they can be, provided some slight adaptations are introduced, perfectly well integrated into a new local context.

Portugal Broadens Its Medical and Wellness Tourism Services: Following a Global Trend In Portugal, ‘health and wellness’ was selected as one of the ten strategic tourism products for the period 2006-2015 in the National Strategic Plan for Tourism. During at least the first half of this time period, the main focus was on termas or mineral springs (Portugal’s pride for centuries and associated with both medical treatments and, from 2004 onward thanks to new legislation, the possibility of exploring the wellness angle and the rejuvenation of the incoming customer group) and spa resorts/hotels (a new trend following the worldwide movement and inviting customers to participate in wellness activities in tap water), as these tourist attractions were able to function in all Portuguese tourism regions to complement other (strategic) tourism products, and to add above average value to the resource/product. Hence, millions of euros have been invested in the construction of new facilities and the modernisation of older, more traditional infrastructures. The upgrading of this tourism sector was expected to enable medical and wellness service companies to be more competitive and attract more national as well as international tourists. At Portuguese mineral spring spas, however, domestic visitors still largely outweigh international visitors (approximately 5%, mostly Spanish).1 Nonetheless, the ‘new’ trend in Portugal is that other segments, namely thalassotherapy and medical tourism, are gaining ground and will probably solidify before 2020, as Portuguese private investors simply want to head into the same direction as the rest of the world with regard to medical and wellness tourism: namely, by broadening the range of quality services offered under the same umbrella. Moreover, with many kilometres of coastline, excellent hotel infrastructures, highly trained human resources, a growing governmental tourism interest and the belief that tourism experts need to collaborate with other sectors, the terrain is well prepared for a positive evolution.

Personal notes taken during the workshop ‘Thermalism in the Euroregion Galicia-North of Portugal’ in the headquarters of the eurocity ChavesVerín on 28 November 2013.

158

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

Sustainability: A Concept Always Ready to Be Applied

159

Each day more and more people know what sustainability is about, and this is partly due to the efforts of major international organisations such as the World Tourism Organization (WTO) and the European Union (EU) who, for example, deliberately dedicate subpages of their websites to this theme: a link on the main page of the WTO website leads to the section ‘Sustainable Development of Tourism’,2 and on the website of the EU you can find different contexts in which the concept is applied, such as the ‘Agenda for a Sustainable and Competitive European Tourism’ that has existed since 2007.3 A ‘Sustainable Tourism’ subpage is hosted at the website of the European Commission,4 and, more recently, another excellent example, the Global Reporting Initiative’s (GRI) ‘Sustainability Reporting Guidelines’, was promoted.5 One more detail will eliminate all doubt about the fact that medical and wellness tourism is a perfect area in which to apply sustainability principles in economic, environmental and sociocultural ways. When in 2010 the European Commission identified Europe as the world's ‘number 1’ tourism destination and stipulated the guidelines of the political framework for tourism in Europe, it formulated its general view on sustainability in the tourism sector. Stating that the sector's competitiveness is closely linked to its sustainability, the Commission emphasized that the sustainability of tourism covered a number of aspects, such as ‘the responsible use of natural resources, taking account of the environmental impact of activities (production of waste, pressure on water, land and biodiversity, etc.), the use of “clean” energy, protection of the heritage and preservation of the natural and cultural integrity of destinations, the quality and sustainability of jobs created, local economic fallout… [and] customer care’. These principles still need to find adequate expression in specific actions. The European Commission regards it as crucial to encourage initiatives which ‘promote responsible management of resources (energy, water, raw materials, etc.) and guarantee optimum conditions for services and safety, particularly when catering for elderly people or those with reduced mobility’.6

Dubious Regulation Should be Banned As we already demonstrated in the introduction of the book, regulation, in a double sense, is crucial. In the first place, different concepts have to be clearly defined. Secondly, explicit rules have to be established and respected. In Portugal, for example, with all the upcoming spas, there is a great need to affirm what a quality spa is. If, on the one hand, the Portuguese mineral spring spas (in Portugal they are called termas) are subject to strict regulation with regard to water quality, the quality and state of infrastructures and equipments that they provide and even the training of their human resources, on the other hand, not a single spa unit working with tap water (be it integrated in a hotel, a resort or a gym), nor a single thalassotherapy centre has to observe a specific set of rules, as no Portuguese legal framework exists for them on how to install, license, develop and provide services. As a result, unequal competitive conditions are established not only between different types of spa, but also between all the different sectors of the medical and wellness industry. An effort will have to be made to ensure that the services provided are comparable at all spas, and thus to guarantee a minimum of quality and safety for the consumer. Another ‘hot’ legislation-related topic is the EU Directive 2011/24/EU of 9 March 2011 on patients’ rights to healthcare abroad. The main objectives of the Directive are to ‘clarify and simplify the rules and procedures applicable to patients’ access to cross-border healthcare; provide EU citizens with better information on their 2 3 4 5 6

Link: http://sdt.unwto.org (accessed 20 November 2013). Link: http://europa.eu/legislation_summaries/enterprise/industry/l10132_en.htm (accessed 20 November 2013). Link: http://ec.europa.eu/enterprise/sectors/tourism/sustainable-tourism/index_en.htm (accessed 20 November 2013). Link: http://ec.europa.eu/environment/resource_efficiency/news/up-to-date_news/03062013_en.htm (accessed 20 November 2013). European Commission, 2010, Europe, the world's No 1 tourist destination – a new political framework for tourism in Europe, COM (2010), 352.

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

rights; ensure that cross-border healthcare is safe and of high quality; and to promote cooperation between Member States’.7 Although the Directive should have been implemented into the laws and systems of each Member State by 25 October 2013, this is still not a reality. Certainly (potential) players in the medical and the thermal spa tourism market urge their governments to make the necessary decisions. Now that we have sketched the general context, we can zoom into some concrete opportunities/challenges for the medical and wellness sector, mainly exploring ideas advanced by the authors of this book. In these cases we do not cite references.

Human and Local Resources: All Hands on Deck on the Supply Side The first central theme to be commented on through the perspectives of the authors of this book is ‘human resources’. Timothy Lee and Boram Lim, studying the Japanese ryokan, see it as essential that training in two or more languages for all the medically and hospitality skilled people who work at spas should be reinforced in order to solve the problems presented by language barriers, and permit thorough internationalisation. Rosa Conde and colleagues add that spa employees must also be able to perform their tasks adequately and professionally, while possessing some knowledge about what else is offered in their spa and done by co-workers. Moreover, they should demonstrate availability, courtesy and individual attention toward the clients, as well as accurately informing them about the timing and duration of their treatments. Also Mei-Ting Hsieh and Timothy Lee recommend maintaining highly skilled and qualified staff through further training in treatment skills. Certainly nowadays, in times of economic crisis, many fiercely competing countries take advantage not only of their human resources, but also of indigenous products that permit high value incorporation in order to guarantee the sustainability of their companies. Spas have especially high fixed energy costs, as they are constantly heating up huge amounts of water and have a great deal of equipment running simultaneously. For these businesses, being sustainable might necessitate replanning their energy management in order to guarantee greater energy independence or at least reduced energy consumption and costs.8 Returning to the authors of this book, Timothy Lee urges Australian spa hoteliers to exploit the superiority of their unique location more effectively, offer health promotion and prevention services, and thus diversify the medical care or rehabilitation packages they offer. He also indicates that spa service providers should offer homemade products using local ingredients, enabling consumers to be closer to the particular geographical space and atmosphere of the spa they have chosen. Rosa Conde and colleagues note something similar in Portugal: namely, that the clients of thermal spas are not only on the lookout for treatments; they are simultaneously eager to have direct contact with nature and enjoy both the peaceful atmosphere and the natural surroundings of their treatment location.

Make Your Product Known A crucial matter is making your product known to possible clients. In this context, Mei-Ting Hsieh and Timothy Lee stress the need for a clear wellness concept, as people must know in advance exactly what they should expect. Timothy Lee and Boram Lim add that there must be more promotional materials written in English or other languages available in order to attract foreign customers to Japanese ryokan. Anja Tuohino Department of Health, 2013, Consultation on UK Implementation of Directive 2011/24/EU (on the application of patients’ rights in cross-border healthcare), [n.p.], 5. 8 Personal notes taken during the workshop ‘Thermalism in the Euroregion Galicia-North of Portugal’ in the headquarters of the eurocity ChavesVerín on 28 November 2013. 7

160

Sustainable Medical and Wellness Destinations | Client-, Result- and Innovation-Focussed Case Studies

161

and Juho Pesonen claim that heavy users of well-being services are familiar with social media services and advise the use of these channels to promote well-being services. Other tools at hand, according to these authors, are search engine optimisation and the launching of marketing campaigns through affiliate websites, travel agentsâ&#x20AC;&#x2122; websites and destination websites. Noelia AraĂşjo Vila and colleagues are more extreme in their approach, suggesting that introducing tourist destinations in a fictional series or in a film is an effective promotional tool. They even observe that the larger the audience and the greater the broadcasting area, the greater the repercussions will be. Timothy Lee suggests another less complex technique: cross-promotion with other tourism products, such as culinary, nature-based and cultural heritage tourism, because packaged products may drive the whole tourism industry and at the same time yield higher profits. An alternative way to charm visitors is to offer individually tailored programs. He likewise argues that the service quality of the packaged spa products should be carefully controlled in order to secure visitors.

More Evidence that Medical and Wellness Tourism Brings Economic Benefits for Local Development The team of Maria JoĂŁo Carneiro stresses in a more evident way the economic benefits for local development generated by investments in medical and wellness tourism. In their case, they found evidence to show that the promotion of a program of social thermal tourism is a relevant strategy, thanks to increased sales and occupation rates, to reduce the seasonality effect in health tourism destinations, and raise the profitability of the economic activities involved in the supply of this tourism product.

Clients Must Remain at the Centre of Attention Last but not least, the client has to remain at the centre of attention. Mei-Ting Hsieh and Timothy Lee recommend exploring suitable medical and/or wellness programs to meet the needs of different groups. Joaquim Antunes found out that understanding the needs of spa goers, customisation and guarantying service quality produce a positive effect on the satisfaction level of the spa goers. Moreover, if they are satisfied, their loyalty can be won more easily. What is needed is what we hope this book will have contributed to: the creation, development and maintenance of profitable and sustainable medical and wellness destinations where regular innovations tempt future clients to visit for the first time, and excellent service and products win loyal customers who return to be treated well again and again.

Organization

Funding